Skip to main content
SpringerLink
Log in
Book cover

Nutritional and Medical Management of Kidney Stones pp 117–122Cite as

Medical Management of Uric Acid Stones

  • Chapter
  • First Online:

Part of the book series: Nutrition and Health ((NH))

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.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  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.

    Article  CAS  PubMed  Google Scholar 

  2. Kamel KS, et al. Recurrent uric acid stones. QJM. 2005;98(1):57–68.

    Article  CAS  PubMed  Google Scholar 

  3. Wiederkehr MR, Moe OW. Uric acid nephrolithiasis: a systemic metabolic disorder. Clin Rev Bone Miner Metab. 2011;9(3–4):207–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Finlayson B, Smith LH. Stability of first dissociable proton of uric acid. J Chem Eng Data. 1974;19:94–7.

    Article  CAS  Google Scholar 

  5. Coe FL. Uric acid and calcium oxalate nephrolithiasis. Kidney Int. 1983;24(3):392–37.

    Article  CAS  PubMed  Google Scholar 

  6. Maiuolo J, et al. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8–14.

    Article  PubMed  Google Scholar 

  7. Abou-Elela A. Epidemiology, pathophysiology, and management of uric acid urolithiasis: a narrative review. J Adv Res. 2017;8:513–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Han H, et al. Nutritional management of kidney stones (nephrolithiasis). Clin Nutr Res. 2015;4(3):137–52.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yu KH, et al. Dietary factors associated with hyperuricemia in adults. Semin Arthritis Rheum. 2008;37(4):243–50.

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  CAS  PubMed  Google Scholar 

  12. Kang D, et al. Long term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. J Urol. 2007;177:1358–62.

    Article  PubMed  Google 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.

    Article  CAS  PubMed  Google Scholar 

  14. Ghadieh HE, et al. Chlorogenic acid/chromium supplement rescues diet-induced insulin resistance and obesity in mice. Nutr Metab. 2015;12:19.

    Article  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google Scholar 

  17. Heilberg IP. Treatment of patients with uric acid stones. Urolithiasis. 2016;44:57–63.

    Article  CAS  PubMed  Google Scholar 

  18. Rho YH, et al. The epidemiology of uric acid and fructose. Semin Nephrol. 2011;31(5):410–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Taylor EN, Curhan GC. Fructose consumption and the risk of kidney stones. Kidney Int. 2008;73:207–12.

    Article  CAS  PubMed  Google Scholar 

  20. Daly M. Sugars, insulin sensitivity, and the postprandial state. Am J Clin Nutr. 2003;78:865S–72S.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Pak CY, et al. Successful management of uric acid nephrolithiasis with potassium citrate. Kidney Int. 1986;30(3):422.

    Article  CAS  PubMed  Google 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.

    Article  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  26. Riese RJ, Sakhaee K. Uric acid nephrolithiasis: pathogenesis and treatment. J Urol. 1992;148:765–71.

    Article  CAS  PubMed  Google Scholar 

  27. McKenzie DC. Changes in urinary pH following bicarbonate loading. Can J Sport Sci. 1988;13(4):254–6.

    CAS  PubMed  Google Scholar 

  28. Cameron JS, Moro F, Simmonds HA. Gout, uric acid and purine metabolism in paediatric nephrology. Pediatr Nephrol. 1993;7(1):105–18.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Wilson FP, et al. Tumor lysis syndrome: new challenges and recent advances. Adv Chronic Kidney Dis. 2014;21(1):18–26.

    Article  PubMed  PubMed Central  Google 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.

    Article  CAS  PubMed  Google Scholar 

  36. Arellano F, Sacristan JA. Allopurinol hypersensitivity syndrome: a review. Ann Pharmacother. 1993;27(3):337–43.

    Article  CAS  PubMed  Google Scholar 

  37. Shamash J, et al. Acetazolamide for alkalinisation of urine in patients receiving high-dose methotrexate. Cancer Chemother Pharmacol. 1991;28:150–1.

    Article  CAS  PubMed  Google 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.

    Article  Google Scholar 

  39. Rubenstein MA, Bucy JG. Acetazolamide induced renal calculi. J Urol. 1975;114:610–2.

    Article  CAS  PubMed  Google Scholar 

  40. Taal MW, et al. Renoprotective benefits of RAS inhibition: from ACEI to angiotensin II antagonists. Kidney Int. 2000;57(5):1803–17.

    Article  CAS  PubMed  Google Scholar 

  41. Burrell LM. Risk-benefit assessment of losartan potassium in the treatment of hypertension. Drug Saf. 1997;16(1):56–65.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Shimontini Mitra & Robert A. Cohen

Authors
  1. Shimontini Mitra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert A. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shimontini Mitra .

Editor information

Editors and Affiliations

  1. Department of Nephrology, Harvard Vanguard Medical Associates, Boston, MA, USA

    Haewook Han

  2. Division of Nephrology, Newton-Wellesley Hospital, Newton, MA, USA

    Walter P. Mutter

  3. Department of Nephrology, Harvard Vanguard Medical Associates, Boston, MA, USA

    Samer Nasser

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mitra, S., Cohen, R.A. (2019). Medical Management of Uric Acid Stones. In: Han, H., Mutter, W., Nasser, S. (eds) Nutritional and Medical Management of Kidney Stones. Nutrition and Health. Humana, Cham. https://doi.org/10.1007/978-3-030-15534-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-15534-6_9

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-15533-9

  • Online ISBN: 978-3-030-15534-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation