Update on the Pathophysiology and Management of Uric Acid Renal Stones

Kenny, Jon‐Émile S.; Goldfarb, David S.

doi:10.1007/s11926-010-0089-y

Cited by 46 publications

(25 citation statements)

References 42 publications

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“…Uric acid stones primarily occur from low urine pH and high urate excretion, and until these metabolic abnormalities are treated, a high rate of recurrence is expected. 32 Brushite stone formers often have hypercalcuria and other metabolic abnormalities (e.g., distal renal tubular acidosis) that contribute to a high rate of recurrence. 31 Recurrent urinary tract infections likely contribute to the higher risk of recurrence with struvite stone.…”

Section: Discussionmentioning

confidence: 99%

Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community

Singh

Enders

Vaughan

et al. 2015

Mayo Clinic Proceedings

110

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Objective To determine the variation in kidney stone composition and its relationship to risk factors and recurrence among first-time stone formers in the general population. Patients and Methods Medical records were manually reviewed and validated for symptomatic kidney stone episodes among Olmsted County, Minnesota residents from January 1, 1984 to December 31, 2012. Clinical and laboratory characteristics and the risk of symptomatic recurrence were compared between stone compositions. Results There were 2961 validated first-time symptomatic kidney stone formers. Stone composition analysis was obtained in 1508 (51%) at the first episode. Stone formers were divided into the following mutually exclusive groups: any brushite (0.9%), any struvite (0.9%), any uric acid (4.8%), majority calcium oxalate (76%) or majority hydroxyapatite (18%). Stone composition varied with clinical characteristics. A multivariable model had a 69% probability of correctly estimating stone composition, but assuming calcium oxalate monohydrate stone was correct 65% of the time. Symptomatic recurrence at 10 years was approximately 50% for brushite, struvite, and uric acid, but approximately 30% for calcium oxalate and hydroxyapatite stones (P<.001). Recurrence was similar across different proportions of calcium oxalate and hydroxyapatite (P-trend=.10). However, among calcium oxalate stones, 10-year recurrence rate ranged from 38% for 100% calcium oxalate dihydrate to 26% for 100% calcium oxalate monohydrate (P-trend=.007). Conclusion Calcium stones are more common (94% of stone formers) than has been previously reported. While clinical and laboratory factors associate with the stone composition, they are of limited utility for estimating stone composition. Rarer stone compositions are more likely to recur.

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Section: Discussionmentioning

confidence: 99%

Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community

Singh

Enders

Vaughan

et al. 2015

Mayo Clinic Proceedings

110

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“…Older adults have higher rates of morbidity from kidney stones and higher risk of infectious complications and comorbid conditions such as diabetes, which can increase uric acid stone formation (5,6). Also, most of them are taking medications and vitamin supplements which change their metabolic profile and increase their susceptibility for stone formation (1).…”

Section: Introductionmentioning

confidence: 99%

Nephrolithiasis in elderly population; effect of demographic characteristics

Moudi¹,

Hosseini²,

Bijani³

2016

J Nephropathol

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BackgroundKidney stone (nephrolithiasis) is one of the most common diseases. During the past several decades, its prevalence and incidence have increased markedly in elderly population.ObjectivesThis study was conducted to evaluate the risk factors for nephrolithiasis in elderly population.Patients and MethodsThis study was based on the Amirkola Health and Ageing Project (AHAP). Elderly people with kidney stones in every size, type and number were considered to be the case group and other subjects without a history of kidney stones served as control group. Demographic and anthropometric data, smoking, diabetes and metabolic syndrome (MetS), calcium (Ca), vitamin D, parathyroid hormone (PTH), uric acid and urine pH were compared in both groups.Results In this study, 1390 elderly people with the mean age of 69.37 ± 7.42 years were evaluated which 202 (14.53%) cases had renal stones. The patients with nephrolithiasis were younger (P = 0.010) and had higher uric acid and body mass index (BMI) levels (P = 0.041 and P = 0.006, respectively). Age <75 years, male gender and BMI ≥30 kg/m2 had a significant association with stone formation. The prevalence of diabetes, MetS and smoking in the patients with nephrolithiasis was lower than the subjects without it. ConclusionsThis study suggests that male gender, obesity and age <75 years might be independent risk factors for the development of nephrolithiasis. Hence, low animal protein intake and weight reduction should be included as part of the counseling of senior stone-formers.

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“…An alternative therapy is to further decrease urinary uric acid concentration utilizing small doses of a xanthine oxidase inhibitor such as allopurinol (100 mg once daily) [25]. Existing calculi may also be ‘dissolved’ utilizing this therapy [26].…”

Section: Introductionmentioning

confidence: 99%

Beware the low urine pH—the major cause of the increased prevalence of nephrolithiasis in the patient with type 2 diabetes

Bell

2011

Diabetes Obesity Metabolism

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There is an increased prevalence of nephrolithiasis and an increase in the incidence of renal colic in patients with diabetes, obesity, hypertension and insulin resistance because of an increased frequency of uric acid crystallization. Uric acid crystallization occurs in the milieu of an acid urine and is not due to hyperuricosuria as with insulin resistance, urinary uric acid levels are generally decreased because of increased renal tubular reabsorption. However, in the presence of insulin resistance, there is decreased renal tubular generation of ammonia and increased sodium absorption leading to acidification of the urine and uric acid crystallization. The presence of a low urine pH should alert the clinician to the increased risk of nephrolithiasis particularly in the obese, diabetic or hypertensive patient. Prevention of nephrolithiasis can be achieved in susceptible individuals either by alkalizing the urine and/or by further decreasing the uric acid content of the urine with a xanthine oxidase inhibitor such as allopurinol.

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Update on the Pathophysiology and Management of Uric Acid Renal Stones

Cited by 46 publications

References 42 publications

Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community

Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community

Nephrolithiasis in elderly population; effect of demographic characteristics

Beware the low urine pH—the major cause of the increased prevalence of nephrolithiasis in the patient with type 2 diabetes

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