Do you recommend treating asymptomatic Proteus urinary infections in patients with alkaline urine and recurrent calcium phosphate nephrolithiasis?

Yes! Proteus species are typically rapid producers of urease, splitting urea to ammonium and raising urine pH, often into the high 7s and precipitating, magnesium, ammonium phosphate stones, otherwise known as struvite.

Your patient’s Proteus infection apparently splits urea more slowly with less ele...

When Proteus is causing stones and alkaline urine, is it via urea hydrolysis? That shows up as high urine ammonia, much above urine sulfate; let's say double the sulfate and often more. With an alkaline urine, kidneys do not do this physiologically. When proteus is in the urine but ammonia levels ar...