From the Guidelines
Tums is not recommended for patients with recurrent kidney stones composed of 95% calcium oxalate monohydrate and 5% calcium phosphate. The American College of Physicians (ACP) guideline recommends management with increased fluid intake spread throughout the day to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis 1. Additionally, pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol may be recommended to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones 1.
Some key points to consider in the management of these patients include:
- Increasing fluid intake to at least 2-3 liters per day to dilute the concentration of stone-forming substances in the urine
- Maintaining normal dietary calcium consumption (1000-1200 mg daily) to avoid increasing urinary calcium levels
- Limiting oxalate-rich foods to reduce the risk of calcium oxalate stone formation
- Considering medications such as thiazide diuretics or potassium citrate to reduce urinary calcium excretion or increase urinary citrate, which inhibits stone formation
It is essential to note that Tums contains calcium carbonate, which could potentially worsen calcium-based kidney stones by increasing urinary calcium levels 1. Therefore, alternative approaches that address the underlying metabolic factors contributing to stone formation should be prioritized.
From the Research
Tums Recommendation for Patients with Recurrent Kidney Stones
- The composition of the kidney stones is 95% calcium oxalate monohydrate and 5% calcium phosphate.
- According to the study 2, thiazide treatment can lower urine calcium and both calcium oxalate and calcium phosphate supersaturations in patients with calcium oxalate and calcium phosphate stones.
- However, the effect of potassium citrate (K-Cit) on the risk of calcium phosphate stone formation is unclear, and it may not confer the same benefits on calcium phosphate stone formers as it does on calcium oxalate stone formers 2.
- The study 3 suggests that patients with calcium oxalate stones containing a calcium phosphate component (> or = 15%) showed higher urinary saturation levels with respect to calcium phosphate.
- Tums, which contains calcium carbonate, may increase urinary calcium levels, which could potentially increase the risk of calcium phosphate stone formation.
- There is no direct evidence to recommend Tums for patients with recurrent kidney stones of this composition, and the use of Tums may depend on individual patient factors and medical history.
- The studies 4, 5, and 6 provide information on the clinical and biochemical differences between patients with pure calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones, but do not specifically address the use of Tums for patients with recurrent kidney stones of this composition.
Considerations for Treatment
- Patients with calcium oxalate monohydrate stones may have lower urinary calcium levels and lower urine pH compared to patients with calcium oxalate dihydrate stones 4.
- Hypercalciuria is more common in patients with calcium oxalate dihydrate stones, while hyperoxaluria is more common in patients with calcium oxalate monohydrate stones 5.
- The hardness of urinary tract stones can vary depending on the crystal phase, with calcium oxalate monohydrate being one of the harder phases 6.