Abstract
We have described our twenty year experience with the use of thiazides in preventing calcium stones in over 500 treated patients. New stone formation ceases completely in at least 90% of patients treated with 50 mg hydrochlorothiazide twice daily if patient compliance is good. Treatment is effective in normocalciuric as well as hypercalciuric patients and in those with medullary sponge kidney. We make no attempt to select patients suitable for thiazides on the basis of the type of hypercalciuria and concomitant allopurinol therapy is not used routinely in hyperuricosuric patients with calcium stones. The remarkable efficacy of thiazides in stone prevention is undoubtedly related to the hypocalcuric action of these diuretics but other effects may be important especially the reduction in urine oxalate excretion which can be demonstrated in most patients treated for more than one year. The causes of apparent thiazide failures are discussed.
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