Acetazolamide and Sodium Bicarbonate Induced Nephrocalcinosis and Nephrolithiasis

Abstract

Acetazolamide was the first potent carbonic anhydrase inhibitor to be introduced. 1 Although it did not fulfill its early promise as a diuretic, 2 it is still used in the treatment of epilepsy and glaucoma. Serious side effects are uncommon, but between 1955 and 1960 there were several reports of ureteral colic in patients taking the drug (Table 1). During an investigation into the value of combined treatment with sodium bicarbonate and carbonic anhydrase inhibitors in patients with uric acid or cystine stones, the development of calcium phosphate nephrolithiasis and nephrocalcinosis within five months was encountered in one patient. In order to clarify the mechanisms involved, some studies were made to determine the effect of this treatment on calcium and citrate excretion. Patient Summary A 38-year-old man had colic in the left ureter in November 1962, and several further attacks in the next four months. No stones were recovered for