How long do you continue a thiazide diuretic in a patient with nephrolithiasis and hypercalciuria who achieves normalization of urinary calcium excretion following therapy initiation?

This question needs to be viewed from many angles in considering the answer. At the first level, an effective therapy choice for stone formation should be continued as long as the patient remains a stone former, which is probably for the rest of their life. We should always remember that the desired endpoint is not a specific urine calcium level, but rather a reduction of stone recurrence rates. Measuring stone recurrence rates is much more difficult than urine calcium levels and requires observ...

The issue is that we recommend increasing water intake for all stone formers. For the vast majority with idiopathic hypERcalciuria, a helpful tip to know if the patient is drinking too much or too little is observing the urine color (too concentrated versus water-like). We need to be mindful of not causing hypOnatremia in those patients. So reducing stone recurrence is the target, not the spot calcium (which can vary based on the hydration status that particular day).