Abstract
Uric acid nephrolithiasis is typically found in individuals with a low urine pH and a normal concentration of urinary uric acid. Patients with a history of gout are at greater risk of forming uric acid stones, as are patients with obesity, diabetes, or the complete metabolic syndrome. The unifying renal tubular abnormality of these disorders appears to be the excretion of abnormally acidic urine. This article focuses on the relationship of these disorders to the development of uric acid stones. The diagnosis of uric acid stones can be elusive, because pure uric acid stones are radiolucent on plain radiographs. Ultrasound, or preferably noncontrast helical CT scanning, is required for their detection. The treatment of uric acid stones should focus on alkalinization of the urine with citrate or bicarbonate salts. Additional interventions such as increase in fluid intake and decrease in animal protein ingestion are often beneficial. Patients with documented hyperuricemia often require specific therapy to lower serum uric acid concentration and subsequent excretion.
Similar content being viewed by others
References and Recommended Reading
Monk RD, Bushinsky DA: Kidney stones. In Williams Textbook of Endocrinology, edn 10. Edited by Larsen PR, Kronenberg HM, Melmed S, Polonsky KS. Philadelphia: W.B. Saunders; 2003:1411–1425.
Monk RD, Bushinsky DA: Nephrolithiasis and nephrocalcinosis. In Comprehensive Clinical Nephrology, edn 2. Edited by Johnson R, Frehally J. London: Mosby; 2003:731–744.
Coe FL, Evan A, Worcester E: Kidney stone disease. J Clin Invest 2005, 115:2598–2608.
Bushinsky DA: Kidney stones. Adv Intern Med 2001, 47:219–238.
Shekarriz B, Stoller ML: Uric acid nephrolithiasis: current concepts and controversies. J Urology 2002, 168:1307–1314.
Wortmann RL, Kelley WN: Gout and hyperuricemia. In Kelley’s Textbook of Rheumatology, edn 7. Edited by Harris E, Budd R, Genovese M, et al. Philadelphia: Elsevier Saunders; 2005:1402–1429.
Choi HK, Curhan G: Gout: epidemiology and lifestyle choices. Curr Opin Rheumatol 2005, 17:341–345.
Kramer HJ, Choi HK, Atkinson K, et al.: The association between gout and nephrolithiasis in men: The Health Professionals’ Follow-Up Study. Kidney Int 2003, 64:1022–1026.
Terkeltaub R, Bushinsky D, Becker M: Recent developments in our understanding of the renal basis of hyperuricemia and the development of novel antihyperuricemic therapeutics. Arthritis Res Ther 2006, 8:S4.
Daudon M, Traxer O, Conort P, et al.: Type 2 diabetes increase the risk for uric acid stones. J Am Soc Neph 2006, 17:2026–2033.
Taylor EN, Stampfer MJ, Curhan GC: Diabetes mellitus and the risk of nephrolithiasis. Kidney Int 2005, 68:1230–1235.
Cameron MA, Maalouf NM, Adams-Huet B, et al.: Urine composition in type 2 diabetes: predispostiion to uric acid nephrolithiasis. J Am Soc Neph 2006, 17:1422–1428.
Yu TF, Gutman AB: Uric acid nephrolithiasis in gout. Ann Intern Med 1967, 67:1133–1148.
Taylor EN, Stampfer MJ, Curhan GC: Obesity, weight gain, and the risk of kidney stones. JAMA 2005, 293:455–462.
Alvarez-Nemegyei J, Medina-Escobedo M, Villanueva-Jorge S, Vasquez-Mellado J: Prevalence and risk factors for urolithiasis in primary gout: is a reappraisal needed? J Rheumatol 2005, 32:2189–2191.
Wallace S, Robinson H, Masi A, et al.: Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977, 20:895–900.
Kramer H, Curhan G: The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988–1994. Am J Kidney Dis 2002, 40:37–42.
Sakhaee K, Adams-Huet B, Moe OW, Pak CY: Pathyophysiologic basis for normouricosuric uric acid nephrolithiasis. Kidney Int 2002, 62:971–979.
Moe OW, Abate N, Sakhaee K: Pathophysiology of uric acid nephrolithiasis. Endo Clin North Am 2002, 31:895–914.
Mount DB, Kwon C, Zandi-Nejad K: Renal urate transport. Rheumatic Disease Clinics of North America 2006, 32:313–331.
Enomoto A, Kimura H, Chairoungdua A, et al.: Molecular identification of a renal urate-anion exchanger that regulates blood urate levels. Nature 2002, 417:447–452.
Pak CY, Sakhaee K, Peterson RD, et al.: Biochemical profile of idiopathic uric acid nephrolithiasis. Kidney Int 2001, 60:757–761.
Henneman PH, Wallach S, Dempsey EF: The metabolic defect responsible for uric acid stone formation. J Clin Invest 1962, 41:537–542.
Asplin JR: Uric acid stones. Semin Nephrol 1996, 16:412–424.
Khatchadourian J, Preminger GM, Whitson PA, et al.: Clinical and biochemical presentation of gouty diathesis: comparison of uric acid versus pure calcium stone formation. J Urol 1995, 154:1665–1669.
Lennon EJ, Lemann J, Jr., Litzow JR: The effects of diet and stool composition on the net external acid balance of normal subjects. J Clin Invest 1966, 45:1601–1607.
Kurtz I, Maher T, Hulter HN, et al.: Effect of diet on plasma acid-base composition in normal humans. Kidney Intl 1983, 24:670–680.
Abate N, Chandalia M, Cabo-Chan AV, et al.: The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kid Int 2004, 65:386–392.
Pak CY, Sakhaee K, Moe O, et al.: Biochemical profile of stone-forming patients with diabetes mellitus. Urology 2003, 61:523–527.
Pak CY, Poindexter JR, Peterson RD, et al.: Biochemical distinction between hyperuricosuric calcium urolithiasis and gouty diathesis. Urology 2002, 60:789–794.
Hediger MA, Johnson RJ, Miyazaki H, Endou H: Molecular physiology of urate transport. Physiology 2005, 20:125–133.
Daudon M, Lacour B, Jungers P: Influence of body size on urinary stone composition in men and women. Urol Res 2006, 34:193–199.
Maalouf NM, Sakhaee K, Parks JH, et al.: Association of urinary pH with body weight in nephrolithiasis. Kidney Int 2004, 65:1422–1425.
Maalouf NM, Cameron MA, Moe OW, Sakhaee K: Novel insights into the pathogenesis of uric acid nephrolithiasis. Curr Opin Nephrol Hypertens 2004, 13:181–189.
Bloomgarden ZT.: Measures of insulin sensitivity. Clin Lab Med 2006, 26:611–633.
Chobanian MC, Hammerman MR: Insulin stimulates ammoniagenesis in canine renal proximal tubular segments. Am J Physiol 1987, 253:F1171–F1177.
Nissim I, States B, Nissim I, et al.: Hormonal regulation of glutamine metabolism by OK cells. Kidney Int 1995, 47:96–105.
Davidson MB, Thakkar S, Hix JK, et al.: Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med 2004, 116:546–554.
Sica D, Schoolwerth AC: Part 1. Uric acid and losartan. Curr Opinion Nephrol Hyperten 2002, 11:475–482.
Feher MD, Hepburn AL, Hogarth MB, et al.: Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout. Rheumatology (Oxford) 2003, 42:321–325.
Milionis HJ, Kakafika AI, Tsouli SG, et al.: Effects of statin treatment on uric acid homeostasis in patients with primary hyperlipidemia. Am Heart J 2004, 148:635–640.
Clive DM: Renal transplant-associated hyperuricemia and gout. J Am Soc Nephrol 2000, 11:974–979.
Worster A, Preyra I, Weaver B, Haines T: The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: A meta-analysis. Ann Emerg Med 2002, 40:280–286.
Coe FL, Favus MJ, Asplin JR: Nephrolithiasis. In The Kidney, edn 7. Edited by Brenner BM. Philadelphia: W.B. Saunders Company; 2004:1819–1866.
Burns J, Gauthier JF, Finlayson B: Dissolution kinetics of uric acid calculi. J Urol 1984, 131:708–711.
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, 155:839–843.
Lemann J Jr, Bushinsky DA, Hamm LL: Bone buffering of acid and base in humans. Am J Physiol Renal Physiol 2003, 285:F811–F832.
Pais VM Jr, Lowe G, Lallas CD, et al.: Xanthine urolithiasis. Urology 2006, 67:1084–2011.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liebman, S.E., Taylor, J.G. & Bushinsky, D.A. Uric acid nephrolithiasis. Curr Rheumatol Rep 9, 251–257 (2007). https://doi.org/10.1007/s11926-007-0040-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11926-007-0040-z