Role of inhibitor deficiency in urolithiasis. II. Deficiency grade-adjusted and intermittent augmentation therapy for magnesium and citrate deficiency.

63 patients with hypocitraturia (44.9% of the total) and 33 patients with hypomagnesiuria (24.8% of the total) received oral magnesium hydroxide and/or Na/K citrate in addition to other therapeutic agents if indicated and a common-sense diet. Hypocitraturic patients were categorized into 3 groups and received 27-81 mEq/day oral citrate according to the deficiency grade. Hypomagnesiuric patients also formed two groups according to the deficiency grade and received 500 and 1,000 mg/day magnesium hydroxide, respectively. Replacement was intermittant and was controlled every 3 months until reaching normal values. We evaluated 28 of 63 hypocitraturic and 15 of 33 hypomagnesiuric patients who had inhibitory deficiency as the sole causal factor of their urolithiasis. After a follow-up of 13.5 +/- 10.2 months, no patient in either group developed a new stone. Citrate and magnesium were increased significantly in the respective groups; calcium and oxalate excretion was lowered, and urine pH and volume increased significantly. A deficiency grade-adjusted and intermittant replacement therapy with Mg and citrate is very effective, has less side effects and ensures good patients compliance.