Do you avoid potassium citrate due to concerns with increasing the urine pH in patients with recurrent struvite nephrolithiasis who also have hypocitraturia?

Thanks for asking! My answer is: In general, "No", but it depends...

Struvite stones can only form at un-physiologically high urine pHs. This situation occurs when urease-producing bacteria cause urinary infection. Urease splits normally occurring urinary urea to ammonium, raising the urine pH >7.0 and precipitating struvite.

The principal treatment is to eradicate the urinary infection, which usually requires stone removal, since the bacteria invade the stone, which has no vascular supply, and antibiotics cannot reach it. Thus, struvite stones should be treated as infected foreign bodies. Although antibiotics can suppress the urinary infection, they cannot eradicate it. When the antibiotic is stopped, the infection worsens, and the struvit...