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Medical dissolution therapy for the treatment of uric acid nephrolithiasis

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A Letter to the Editor to this article was published on 06 December 2019

Abstract

Introduction

Uric acid (UA) nephrolithiasis represents 10% of kidney stones in the US with low urine pH and high saturation of UA as the main risk factors for stone development. Dissolution therapy for UA kidney stones via urinary alkalization has been described as a treatment option. We present our experience in treating UA nephrolithiasis with medical dissolution therapy.

Methods

A retrospective review was performed of UA stone patients referred for surgery but treated with dissolution therapy between July 2007 and July 2016. Patients were identified using ICD-9 codes. Patients were treated with potassium citrate alone or in combination with allopurinol. Serial imaging and urine pH were obtained at follow-up. Demographics, aggregate stone size, time to stone clearance, urine pH (office dip), and complications were recorded.

Results obtained

Twenty-four patients (14 men and 10 women) were identified that started medical dissolution therapy for UA nephrolithiasis after initial referral for surgical management. Three patients (13%) did not tolerate the initiation of dissolution therapy and discontinued this treatment. Of the 21 patients that were maintained on dissolution therapy, 14 patients (67%) showed complete resolution of nephrolithiasis and 7 patients (33%) showed partial reduction. Patients with partial response had a mean reduction in stone burden of 68%. There were 3 recorded complications (UTI, GI upset with therapy, and throat irritation) and 4 recorded stone recurrences among these 21 patients.

Conclusion

Based on our study population, medical dissolution therapy is a well-tolerated, non-invasive option for UA nephrolithiasis.

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Abbreviations

AUA:

American Urological Association

BMI:

Body Mass Index

CT:

Computed tomography

GI:

Gastrointestinal

KUB:

Kidney, ureter, and bladder X-ray

RUS:

Renal ultrasound

SD:

Standard deviation

UA:

Uric acid

UTI:

Urinary tract infection

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Funding

The authors have no competing interests to disclose.

Author information

Authors and Affiliations

  1. Department of Urology, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH, 43212, USA

    Chad M. Gridley, Michael W. Sourial & Bodo E. Knudsen

  2. Center for Biostatistics, The Ohio State University, Columbus, OH, USA

    Amy Lehman

Authors
  1. Chad M. Gridley
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  2. Michael W. Sourial
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  3. Amy Lehman
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  4. Bodo E. Knudsen
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Contributions

CMG data collection, manuscript writing and editing. MWS data collection and manuscript editing. AL data analysis and manuscript editing. BEK study design, project development, and manuscript editing.

Corresponding author

Correspondence to Bodo E. Knudsen.

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Conflict of interest

Bodo Knudsen is a consultant for Olympus Surgical, Boston Scientific, Thermedx, and Bard Medical. The remaining authors have no disclosures

Ethical approval

The study was approved by the Ohio State University Office of Responsible Research Practices Institutional Review Board (IRB) and conducted in accordance with this. Patient consent was waived by the IRB given the retrospective study design.

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Gridley, C.M., Sourial, M.W., Lehman, A. et al. Medical dissolution therapy for the treatment of uric acid nephrolithiasis. World J Urol 37, 2509–2515 (2019). https://doi.org/10.1007/s00345-019-02688-9

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  • DOI: https://doi.org/10.1007/s00345-019-02688-9

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