Would you start potassium citrate for a patient with recurrent calcium oxalate nephrolithiasis who has normal urinary citrate levels but persistent acidic urine?

An excellent, fundamental question!

Before starting medical treatment, I want to know if the patient’s stone burden is increasing in volume. That requires, in my opinion, serial CT scans, typically annually.

If the stone burden is increasing in volume, it’s time for metabolic (non-surgical) treatment....

No. To what purpose?

Potassium citrate is one of several possibilities for dealing with low pH. It remains relatively expensive, but I would use it if circumstances warranted (e.g., relatively low serum potassium). I most frequently use calcium carbonate or calcium citrate with meals as a dietary calcium source, which a...

Would want to follow regularly for stone burden, however, acidic urine does not cause calcium oxalate stones, however, would want to know what the uric acid supersaturation is as it can be a nidus for calcium stones. If elevated, then I would want to alkalinize the urine a bit.