<prompt> All are indicated in a patient with cystinuria with multiple renal stones exceptCysteamineIncrease fluid intakeAlkalinization of urinePenicillamine  <response>: Ans. a. Cysteamine Patient with cystinuria with multiple renal stones should be treated with increase urine volume high fluid intake, alkalinization of urine Penicillamine and tiopronin. Cystinuria AR Inheritance: Autosomal recessive Molecular defect: Shared dibasic cystine transpoer SLC3A1, SLC7A9Q Tissue manifesting transpo defect: Proximal renal tubule, jejunal mucosaQ Individual substrate: COLA Cystine, Ornithine, Lysine, ArginineQ Clinical features: Cystine nephrolithiasisQ Treatment: Increase urine volumeQ high fluid intake Alkalinization of urineQ PenicillamineQ and tiopronin undergoes sulfhydryl-disulphide exchange with cystine to form mixed disulphides, since these disulphides are much soluble than cystine, pharmacologic therapy can prevent and promote dissolution of calculi 