Medical Management of Uric Acid Stones
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Abstract
Uric acid stones, the second most common type of kidney stones, are associated with significant morbidity. Risk factors include low urine volume, increased uric acid production or excretion, a high-purine diet, and acidic urinary pH. Dietary recommendations to prevent uric acid stones include increasing fluids to produce greater than 2 liters of urine a day and a reduction of animal protein and alcohol. The last two measures decrease uric acid production. Observational data suggest dietary fructose reduction confers benefit. A vegetarian, low sodium diet, rich in citrate containing foods may be most beneficial. Pharmacologic approaches include oral citrate or bicarbonate therapy to increase urinary pH or xanthine oxidase inhibitors to decrease uric acid production.
Keywords
Uric acid Urolithiasis Urate Alkalinization HyperuricemiaReferences
- 1.Borghi L, Meschi T, Amato F, et al. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155:839.PubMedCrossRefGoogle Scholar
- 2.Kamel KS, et al. Recurrent uric acid stones. QJM. 2005;98(1):57–68.PubMedCrossRefGoogle Scholar
- 3.Wiederkehr MR, Moe OW. Uric acid nephrolithiasis: a systemic metabolic disorder. Clin Rev Bone Miner Metab. 2011;9(3–4):207–17.PubMedPubMedCentralCrossRefGoogle Scholar
- 4.Finlayson B, Smith LH. Stability of first dissociable proton of uric acid. J Chem Eng Data. 1974;19:94–7.CrossRefGoogle Scholar
- 5.Coe FL. Uric acid and calcium oxalate nephrolithiasis. Kidney Int. 1983;24(3):392–37.PubMedCrossRefGoogle Scholar
- 6.Maiuolo J, et al. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8–14.PubMedCrossRefGoogle Scholar
- 7.Abou-Elela A. Epidemiology, pathophysiology, and management of uric acid urolithiasis: a narrative review. J Adv Res. 2017;8:513–27.PubMedPubMedCentralCrossRefGoogle Scholar
- 8.Han H, et al. Nutritional management of kidney stones (nephrolithiasis). Clin Nutr Res. 2015;4(3):137–52.PubMedPubMedCentralCrossRefGoogle Scholar
- 9.Yu KH, et al. Dietary factors associated with hyperuricemia in adults. Semin Arthritis Rheum. 2008;37(4):243–50.PubMedCrossRefGoogle Scholar
- 10.Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005;52:283–9. https://doi.org/10.1002/art.20761.PubMedCrossRefGoogle Scholar
- 11.Odvina C. Comparative value of orange juice versus lemonade in reducing stone-forming risk. Clin J Am Soc Nephrol. 2006;1:1269–74.PubMedCrossRefGoogle Scholar
- 12.Kang D, et al. Long term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. J Urol. 2007;177:1358–62.PubMedCrossRefGoogle Scholar
- 13.Choi HK, Curhan G. Coffee, tea, and caffeine consumption and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2007;57:816–21.PubMedCrossRefGoogle Scholar
- 14.Ghadieh HE, et al. Chlorogenic acid/chromium supplement rescues diet-induced insulin resistance and obesity in mice. Nutr Metab. 2015;12:19.CrossRefGoogle Scholar
- 15.Dragan S, Andrica F, Serban MC, Timar R. Polyphenols-rich natural products for treatment of diabetes. Curr Med Chem. 2015;22:14–22.PubMedCrossRefGoogle Scholar
- 16.Karagulle O, et al. Clinical study on the effect of mineral waters containing bicarbonate on the risk of urinary stone formation in patients with multiple episodes of CaOx-urolithiasis. World J Urol. 2007;25(3):315–23.PubMedCrossRefGoogle Scholar
- 17.Heilberg IP. Treatment of patients with uric acid stones. Urolithiasis. 2016;44:57–63.PubMedCrossRefGoogle Scholar
- 18.Rho YH, et al. The epidemiology of uric acid and fructose. Semin Nephrol. 2011;31(5):410–9.PubMedPubMedCentralCrossRefGoogle Scholar
- 19.Taylor EN, Curhan GC. Fructose consumption and the risk of kidney stones. Kidney Int. 2008;73:207–12.PubMedCrossRefGoogle Scholar
- 20.Daly M. Sugars, insulin sensitivity, and the postprandial state. Am J Clin Nutr. 2003;78:865S–72S.PubMedCrossRefGoogle Scholar
- 21.Taylor EN, Fung TT, Curhan GC. DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol. 2009;20(10):2253–9.PubMedPubMedCentralCrossRefGoogle Scholar
- 22.Pak CY, et al. Successful management of uric acid nephrolithiasis with potassium citrate. Kidney Int. 1986;30(3):422.PubMedCrossRefGoogle Scholar
- 23.Wang L, et al. Safety of potassium-bearing citrate in patients with renal transplantation. A case report. Medicine (Baltimore). 2017;96(42):e6933.CrossRefGoogle Scholar
- 24.Cameron MA, et al. The diurnal variation in urine acidification differs between normal individuals and uric acid stone formers. Kidney Int. 2012;81(11):1123–30.PubMedPubMedCentralCrossRefGoogle Scholar
- 25.Rodman JS. Intermittent versus continuous alkaline therapy for uric acid stones and ureteral stones of uncertain composition. Urology. 2002;60(3):378–82.PubMedCrossRefGoogle Scholar
- 26.Riese RJ, Sakhaee K. Uric acid nephrolithiasis: pathogenesis and treatment. J Urol. 1992;148:765–71.PubMedCrossRefGoogle Scholar
- 27.McKenzie DC. Changes in urinary pH following bicarbonate loading. Can J Sport Sci. 1988;13(4):254–6.PubMedGoogle Scholar
- 28.Cameron JS, Moro F, Simmonds HA. Gout, uric acid and purine metabolism in paediatric nephrology. Pediatr Nephrol. 1993;7(1):105–18.PubMedCrossRefGoogle Scholar
- 29.Anderson E, et al. Allopurinol control hyperurocosuria: a new concept in the prevention uric acid stones. J Urol. 1967;97(2):344–7.PubMedCrossRefGoogle Scholar
- 30.Ettinger B, et al. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med. 1986;315(22):1386.PubMedCrossRefGoogle Scholar
- 31.Becker MA, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005;353(23):2450–61.PubMedCrossRefGoogle Scholar
- 32.Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26:2767–78.PubMedCrossRefGoogle Scholar
- 33.Conger JD, Falk SA. Intrarenal dynamics in the pathogenesis and prevention of acute urate nephropathy. J Clin Invest. 1977;59(5):786–93.PubMedPubMedCentralCrossRefGoogle Scholar
- 34.Wilson FP, et al. Tumor lysis syndrome: new challenges and recent advances. Adv Chronic Kidney Dis. 2014;21(1):18–26.PubMedPubMedCentralCrossRefGoogle Scholar
- 35.Takir M, et al. Lowering uric acid with allopurinol improves insulin resistance and systemic inflammation in asymptomatic hyperuricemia. J Investig Med. 2015;63(8):924–9.PubMedCrossRefGoogle Scholar
- 36.Arellano F, Sacristan JA. Allopurinol hypersensitivity syndrome: a review. Ann Pharmacother. 1993;27(3):337–43.PubMedCrossRefGoogle Scholar
- 37.Shamash J, et al. Acetazolamide for alkalinisation of urine in patients receiving high-dose methotrexate. Cancer Chemother Pharmacol. 1991;28:150–1.PubMedCrossRefGoogle Scholar
- 38.Sterett SP, et al. Acetazolamide is an effective adjunct for urinary alkalization in patients with uric acid and cysteine stone formation recalcitrant to potassium citrate. Urology. 2008;72(2):278–81.CrossRefGoogle Scholar
- 39.Rubenstein MA, Bucy JG. Acetazolamide induced renal calculi. J Urol. 1975;114:610–2.PubMedCrossRefGoogle Scholar
- 40.Taal MW, et al. Renoprotective benefits of RAS inhibition: from ACEI to angiotensin II antagonists. Kidney Int. 2000;57(5):1803–17.PubMedCrossRefGoogle Scholar
- 41.Burrell LM. Risk-benefit assessment of losartan potassium in the treatment of hypertension. Drug Saf. 1997;16(1):56–65.PubMedCrossRefGoogle Scholar