Medical dissolution therapy for the treatment of uric acid nephrolithiasis
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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.
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.
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.
Based on our study population, medical dissolution therapy is a well-tolerated, non-invasive option for UA nephrolithiasis.
KeywordsUric acid Nephrolithiasis Dissolution Alkalization
American Urological Association
Body Mass Index
Kidney, ureter, and bladder X-ray
Urinary tract infection
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.
Source of funding
The authors have no competing interests to disclose.
Compliance with ethical standards
Conflict of interest
Bodo Knudsen is a consultant for Olympus Surgical, Boston Scientific, Thermedx, and Bard Medical. The remaining authors have no disclosures
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.