Acetazolamide and Sodium Bicarbonate Induced Nephrocalcinosis and Nephrolithiasis

Raising Urinary Citrate Lowers Calcium Oxalate and Calcium Phosphate Crystal Formation in Whole Urine

“…As long ago as 1931 it was known that citrate played a role in keeping sparingly soluble calcium salts in solution in urine [1] and this conclusion has been supported by many others over the years [2,3], Urinary citrate was found to be low in idiopathic stone formation [4] as well as other causes of urolithiasis such as steatorrhoea [5] and acetazolamide therapy [6,7], Nevertheless, there are still some who dispute that citrate really has a role in urine in preventing calcium salt pre cipitation [8][9][10], and further evidence on the matter seems required. In view of the fact that uromucoids trig ger precipitation in urine of both calcium oxalate and cal cium phosphate [11,12], it seemed desirable to perform any new studies on whole urine.…”

Tamm-Horsfall Protein Accumulation in Glomeruli during Acetazolamide-Induced Acute Renal Failure

“…Evolution was characterized by prompt recov ery of diuresis and return to normal renal function. At day 6 after admission, the creatinine plasma level was 110 pmol/1.Anuric acute renal failure is a rare complication of treatment with acetazolamide, usually occurring during the first days of treatment [2], Some of these cases of anuria are clearly due to intrauretric precipitation of sul fonamide crystals, but other cases with only tubular cell damage are poorly understood. Our report confirms that acetazolamide-induced ARF can be observed in the ab sence of pyeloureteric obstruction since (1) ultrasound examination and IVP excluded urinary tract obstruc tion; (2) urine sieving was negative; (3) renal biopsy showed the presence of tubular lesions associated with intratubular crystal formation.…”

Diuretics

“…Volume expansion and mechanical relief of obstruction have been advocated in the treatment of this condition. However, the administration of sodium bicarbonate is controversial, since it may predispose to the development of calcium phosphate stones [62,63]. Renal calculi have also been reported associated with acetazolamide use [63][64][65][66][67] and as the result of the administration of triamterene [68,69].…”