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Role of the oral medication in kidney stone treatment

Role of the Potassium citrate in kidney stone treatment
FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

The FAQ (Frequently ask question) from patients at Urology clinic; what about Potassium citrate therapy for kidney stone treatment or stone prevention for the post successful stone operation? In this point I have to answer that the “Most of kidney stone cannot be treated or get rid them of by just the medication but it more likely just has a key role on reducing the recurrence rate”. I will tell you why?

Role of the Potassium citrate in kidney stone treatment
pepper powder on wood spoon

As we see now the over-the-counter medications which are claiming themselves as kidney stone treatment wider and mostly Potassium citrate salts included always claim to be in the ingredient substantial. The “Potassium citrate salts” has 2 protective effects against the kidney stone that would be shown as below.

Pharmacist
Citrate supplement can be easily found over-the-counter

2 Protective effects of Potassium citrate against kidney stone

  1. Potassium citrate salts can alkalinize urine – Be aware that Uric acid stone is the only kind of stone which love acidic urine. The oral citrate therapy with a regular self-checks urine pH and keeping at therapeutic urine pH 6.5 – 7.0 can easily dissolve the stone. The recent literature from Thailand showed that in 100 stone patients for about 20.9% were found as uric acid stone patients so there would be around 1 of 5 got chance that the oral citrate salts will be able to get rid of your stone. (Epidemiology of Uric acid stone’s patients has been varied among the ethnicity, diets and the definite investigation on the kidney stone composition is catching stone for stone analysis)
pH
Potassium citrate therapy makes urine alkalinized which can treat uric acid stone
  1. Citrate itself has ability on Calcium stone prevention – Calcium-containing kidney stone is reported up to 80% of all of kidney burden. Citrate has named as kidney stone inhibitor; it cans bind to the calcium ion in the urine and inhibit crystallization resulting in reduce stone formation. There was a large systematic review since 2015 showed that citrate therapy significantly prevents stone growing and reduce stone recurrence rate.

Potassium citrate therapy might sound a better idea in term of kidney stone prevention, right? Now let’s take a look on its cons.

  • Citrate therapy has been reported on gastrointestinal adverse effects for example, stomach upset, nausea, bloating and diarrhea.
  • Good clinical outcome from citrate therapy needs a very well-compliance because we must keep urine’s citrate level in therapeutic level as much as possible. Serious taking the medication 3 times per day with regularly urine pH self-check-up is the main reason that the patients refuse to continue the citrate therapy.
  • Despite patients very strictly with every single step on citrate therapy, but still no guarantee that they won’t get any suffering from the other stone problem may causes, because kidney stone formation will always cause from multifactorial etiology.
Stomach upset
Stomach upset is usually complaint during citrate therapy
Upset patient
Even perfect compliment but 100% guarantee that the stone will not recur again

It’s better to discuss with your urologist whether your stone condition is worth for citrate therapy or not. Please feel free to text me or if you’d like to discuss relatively to the above topic. Take care!

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