May be at high risk of recurrence.
Form in (relatively) alkaline urine pH > 6.5
Consider:
- Hyperparathyroidism
- RTA
- Recurrent UTIs
- Carbonic anhydrase inhibitors – topiramate, acetazolamide (systemic intracellular metabolic acidosis, inability to acidify the urine reminiscent of RTA)
Metabolic workup should generally be done, considering above potential diagnoses.
Treatment:
- General stone prevention methods – hydration, low salt, lose weight
- Exclude causes such as hyperPTH
- Treat urine infections, stop offending medications
- Depending on workup
- Potassium citrate if hypocitraturia
- HCT if hypercalciuria