BERKELEY, CA (UroToday.com) - Thiazide diuretics are the most commonly used medication for the treatment of calculus associated idiopathic hypercalciuria. On average, thiazide therapy results in a 50% drop in urine calcium levels. What parameters should one follow while patients are on chronic thiazide therapy? While classically, potassium is monitored, these authors suggest that one should also follow serum uric acid, glucose, and lipid levels. Indeed, the relative risk for developing diabetes while on thiazide therapy for hypertension is 1.2-1.45; whether this applies to normotensive stone patients remains undetermined. Similarly, total cholesterol, LDL, and triglycerides are all known to increase while on prolonged antihypertensive thiazide therapy.

Of note, in this review of nine randomized trials of thiazide therapy in urolithiasis patients, while potassium fell and serum uric acid levels routinely rose, there was interestingly no change in glucose or lipid levels, albeit in a rather small patient pool. Replacement of potassium in hypokalemic patients is important as the hypokalemic state may lead to worsening hypocitraturia and glucose intolerance. Lastly, one must be aware of the 3-9% risk of sexual dysfunction in both genders. All of these effects appear to be dose related, hence when embarking on thiazide therapy in urolithiasis hypercalciuric patients, the lowest effective dose should be used (e.g. 12.5 mg of chlorthalidone a day or 25 mg of hydrochlorthiazide twice a day).

Huen SC, Goldfarb DS

Journal of Urology 177(4): 1238-1243, April 2007

UroToday.com Urolithiasis Section

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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