Which diuretic is the drug of choice for treating acidic stones?

The drug of choice for treating acidic stones is acetazolamide. This medication is a carbonic anhydrase inhibitor that alters urinary pH by promoting the excretion of bicarbonate. As bicarbonate is excreted, this can lead to a decrease in urine acidity, helping to mitigate the formation of uric acid stones, which are more likely to form in acidic urine.

When treating patients with a history of recurrent uric acid stones, the goal is often to alkalinize the urine. Acetazolamide achieves this effect by reducing the reabsorption of bicarbonate in the proximal convoluted tubule, thereby increasing bicarbonate in the urine and shifting the pH towards a more alkaline state. This change in pH helps dissolve existing uric acid stones and prevents future stone formation by maintaining a more favorable environment in the urinary tract.

In contrast, other diuretics listed, such as furosemide and hydrochlorothiazide, do not have the same mechanism for altering urinary pH and are not specifically indicated for the treatment of acidic stones. Spironolactone, a potassium-sparing diuretic, does not effectively address the issue of acidic urine and stone formation either. Hence, acetazolamide stands out as