Would you prescribe a thiazide diuretic for patients with recurrent nephrolithiasis attributed to hypercalciuria in the setting of excess dietary sodium or animal protein intake who fail or are unwilling to adhere to recommended dietary changes?

Yes. Difficulty with dietary compliance is common, but there is no sense in being punitive about non-compliance. I would use what other treatments are available.

Caveat emptor! A high sodium diet coupled with a thiazide diuretic often equals hypokalemia. Potassium supplementation might be in order, and depending on stone type, I would add potassium citrate for additional stone prevention. this will also contribute to urinary alkalinization. If a prominent component of the patient's stones has been calcium phosphate, then I would supply potassium as potassium chloride.

Stephen B. Erickson, MD