Acetazolamide Is an Effective Adjunct for Urinary Alkalization in Patients With Uric Acid and Cystine Stone Formation Recalcitrant to Potassium Citrate

CUA guideline on the evaluation and medical management of the kidney stone patient ‒ 2016 update

“…Acetazolamide may be used as an adjunct to urinary alkalinization when potassium citrate alone is ineffective. 143 If alkalizing agents fail to adequately control cystine stone formation, thiol binding agents, such as penicillamine 1-2 g or tiopronin 800-120 0mg in daily divided doses, may be used. 136,[144][145][146] Side effects from penicillamine can be significant and include fever, arthralgias, rash, dysgeusia, leucopenia, and proteinuria.…”

Metaphylaxis in Pediatric Urinary Stone Disease

“…Including acetazolamide in citrate therapy at night signiicantly raises urine pH in patients with cysteine and uric-acid stones, but half of these patients discontinue the drug due to side efects [51]. In addition, high urine pH may lead to calciumphosphate stones [52,53].…”

Nephrolithiasis and Chronic Kidney Disease

“…135 In patients at risk for hyperkalemia, acetazolamide can be used instead of increasing potassium citrate therapy, to increase urinary bicarbonate excretion, urine pH and reduce the risk of uric acid stones. 136 If patients continue to form uric acid stones, or excrete uric acid in excess of 1000 mg/day, allopurinol is recommended to decrease uric acid stone formation. 137 Allopurinol reduces the incidence of calcium stones in hyperuricosuric patients.…”