Uric Acid Nephrolithiasis: Current Concepts and Controversies

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Review Articles1 Oct 2002Uric Acid Nephrolithiasis: Current Concepts and Controversies Bijan Shekarriz and Marshall L. Stoller Bijan ShekarrizBijan Shekarriz and Marshall L. StollerMarshall L. Stoller View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64439-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Uric acid calculi with or without a calcium component comprise a significant proportion of urinary stones. Knowledge of the pathophysiology of stone formation is important to direct medical treatment. The aim of this review is to provide an update on the epidemiology, pathophysiology and management of uric acid renal stones. Materials and Methods: A MEDLINE search was performed on the topic of uric acid stones. Current literature was reviewed with regard to the epidemiology, pathophysiology, associated medical conditions and management of uric acid stones. Results: The incidence of uric acid stones varies between countries and accounts for 5% to 40% of all urinary calculi. Hyperuricuria, low urinary output and acidic urine are well known contributing factors. However, the most important factor for uric acid stone formation is persistently acidic urine. Gout and myeloproliferative disorders are associated with uric acid stones. Why most patients with gout present with acidic urine yet only 20% have uric acid stone formation remains unclear. The pathophysiological basis for persistent urine acidity also remains unclear although various mechanisms have been proposed. Urinary alkalization with potassium citrate or sodium bicarbonate is a highly effective treatment, resulting in dissolution of existing stones and prevention of recurrence. Conclusions: Acidic urine is a prerequisite for uric acid stone formation and growth. Medical management with urinary alkalization for stone dissolution and prevention of recurrence is effective and should be the cornerstone of treatment. References 1 : Nucleation and growth of brushite and calcium oxalate in urine of stone-formers. Metabolism1976; 25: 665. Crossref, Medline, Google Scholar 2 : Uric acid nephrolithiasis. Am J Med1968; 45: 756. Crossref, Medline, Google Scholar 3 : Urinary tract stone disease in the United States veteran population. II. Geographical analysis of variations in composition. J Urol1989; 142: 1516. Link, Google Scholar 4 : Geriatric urolithiasis. J Urol1997; 158: 2221. Link, Google Scholar 5 : Uric acid nephrolithiasis: pathogenesis and treatment. J Urol1992; 148: 765. Link, Google Scholar 6 : Uric acid dihydrate as urinary calculus component. Invest Urol1975; 12: 405. Medline, Google Scholar 7 : Composition of renal stones and their frequency in a stone clinic: relationship to parameters of mineral metabolism in serum and urine. Urol Res1979; 7: 161. Crossref, Medline, Google Scholar 8 : The severity of infection stones compared to other stones in the upper urinary tract. Scand J Urol Nephrol1985; 19: 285. Crossref, Medline, Google Scholar 9 : Uric Acid Lithiasis. New York: Elsevier Publishing Co.1963. Google Scholar 10 : Mineral composition of 103 stones from Iran. Br J Urol1983; 55: 465. Crossref, Medline, Google Scholar 11 : Michelangelo: art, anatomy, and the kidney. Kidney Int2000; 57: 1190. Crossref, Medline, Google Scholar 12 Fourcroy, A. F.: General system of chemical knowledge. London, vol. 11, 1804 Google Scholar 13 : The chemistry of urinary stones around 1800: a first in clinical chemistry. Kidney Int1995; 48: 876. Crossref, Medline, Google Scholar 14 Carl Wilhelm Scheele (1742−1786) Swedish apothecary. JAMA1970; 212: 2258. Crossref, Medline, Google Scholar 15 Pearson: Experiments and observations tending to show the composition and properties of urinary concretions. Phil Trans1798; : 15. Google Scholar 16 : Uric acid metabolism in the Dalmatian coach hound. J S Afr Vet Assoc1982; 53: 201. Medline, Google Scholar 17 : Stability of first dissociable proton of uric acid. J Chem Eng Data1974; 19: 94. Crossref, Google Scholar 18 : A three-component system for renal excretion of uric acid in man. Trans Ass Am Physicians1961; 74: 353. Medline, Google Scholar 19 : Origins of the uricosuric response. J Clin Invest1973; 52: 1368. Crossref, Medline, Google Scholar 20 : Uric acid nephrolithiasis. Miner Electrolyte Metab1994; 20: 424. Medline, Google Scholar 21 : Uric acid calculi: types, etiology and mechanisms of formation. Clin Chim Acta2000; 302: 89. Crossref, Medline, Google Scholar 22 : Urinary pH. J Urol1959; 81: 339. Link, Google Scholar 23 : The role of the diurnal variation of urinary pH in determining stone compositions. J Urol1993; 150: 1437. Link, Google Scholar 24 : Uric acid nephrolithiasis in gout: predisposing factors. Ann Intern Med1967; 67: 1133. Crossref, Medline, Google Scholar 25 : Idiopathic uric acid lithiasis: epidemiologic and metabolic aspects. J Urol1982; 128: 1219. L