Abstract
Uric acid stones are more common in older patients. Their formation usually requires a persistently acid urine. Conversely, they can be dissolved and their re-formation prevented by the use of alkaline salt therapy.
This paper discusses the spectrum of uric acid stone disease including the frequent presentation as a recurrent gravel/colic syndrome. It reviews the clinical situations in which uric acid stones often form and outlines an approach to dissolution of stones using either oral therapy or urinary tract irrigation. Prophylaxis of further stone formation is often possible with only alternate day, single dose treatment with alkaline potassium salts.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Bibliography
Gutman AB, Yu TF. Uric acid nephrolithiasis. Am J Med 1968; 45:756.
Agarwal BN, Cabebe FG. Renal acidification in elderly subjects. Nephron 1980; 26: 291–5.
Barzel US, Sperling O, Frank M, DeVries A. Renal ammonium excretion and urinary pH in idiopathic uric acid lithiasis. J Urol 1964; 92: 1–5.
Rodman JS, Williams JJ, Peterson CM. Dissolution of uric acid calculi. J Urol 1984; 131: 1039–44.
Rodman JS. Prophylaxis of uric acid stones with alternate day doses of alkaline potassium salts. J Urol 1991; 145: 97–9.
Coe FL. Uric acid and calcium oxalate nephrolithiasis. Kidney Int 1983; 24: 392.
Wilcox WR, Khalaf A, Weinberger A, Kippen I, Klineberg R. Solubility of uric acid and monosodium urate. Med Biol Eng Comput 1972; 10: 522.
Pak CYC, Waters O, Arnold L, Holt K, Cox C, Barilla D. Mechanisms for calcium urolithiasis among patients with hyperuricosuria; supersaturation of urine with respect to monosodium urate. J Clin Invest 1977; 56: 426.
Yu TF. Urolithiasis in hyperuricemia and gout. J Urol 1981;126:424.
Matzkies F, Berg G. The urocosuric action of amino acids in men. Adv Exp Med Biol 1977; 76B: 36.
Gibson T, Hannan SF, Hatfield PJ, Simmonds HA, Cameron JS, Potter CS, Crute CM. The effect of acid loading on renal excretion of uric acid and ammonium in gout. Adv Exp Med Biol 1977; 76B: 46.
Loffler W, Grobner W, Zollner N. Influence of dietary protein on serum and urinary uric acid. Adv Exp Med Biol 1980; 122A: 209.
Sakhaee K, Nicar M, Hill K, Pak CYC. Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone forming salts. Kidney Int 1983; 24: 348.
Rodman JS, Vaughan ED Jr. Irrigation of the urinary tract to dissolve stones. American Urological Association Update Series. In press.
Sadi MV, Saltzman N, Feria G, Gittes RF. Experimental observations on dissolution of uric acid calculi. J Urol 1985; 134: 575–9.
Chernesky CE, Rodman JS, Reckler J, Rotterdam H, Marion D, Vaughan ED Jr. Urothelial injury to the rabbit bladder from alkaline irrigants useful in the treatment of uric acid stones. J Urol 1987; 138: 893–4.
Dretler SP, Pfister RC. Percutaneous dissolution of renal calculi. Ann Rev Med 1983; 34: 359–66.
Fuchs GJ, Stenzl A, Zimmern P, Royce PL. Results of non-surgical uric acid and cystine calculi treatment. In: Walker VR, Sutton RAL, Cameron EC, Pak CYC, Robertson WG, editors. New York, London: Urolithiasis, Plenum Presses, 1989: 963–5.
Hosking DH, Erickson SB, VanDenBerg CJ, Wilson DM, Smith LH. The stone clinic effect in patients with idiopathic calcium urolithiasis. J Urol 1983;130: 1115.
Asper R. Epidemiology and socioeconomic aspects of urolithiasis. Urol Res 1984; 12:1–5.
Zechner O, Scheiber V. The role of affluence in recurrent stone formation. In: Smith LH, editor. Urolithiasis basic and clinical research. New York, London: Plenum Presses, 1981: 309–13.
Robertson WG, Peacock M, Heyburr PJ, Rutherford A, Sergeant VJ, Bambach CP. A risk factor model of stone formation: application to the study of epidemiological factors in the genesis of calcium stones. In: Smith LH, editor. Urolithiasis basic and clinical research. New York, London: Plenum Presses, 1981: 303–7.
Pak CYC, Waters O, Arnold L, Holt K, Cox C, Barilla D. Mechanism for calcium urohthiasis among patients with hyperuricosuria. J Clin Invest 1977; 59: 426–31.
Robertson WG, Knowles F, Peacock M. Urinary acid mucopolysaccharide inhibitors of calcium oxalate crystallization. In: Fleisch H, Robertson WG, Smith LH, editors. Urolithiasis research. New York: Plenum Press, 1976: 331–4.
Ettinger B. Does hyperuricosuria play a role in calcium oxalate lithiasis? J Urol 1989;141: 738–40.
Simpson DP. Citrate excretion: a window on renal metabolism. Am J Physiol 1983; 244: 223–34.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rodman, J.S. Management of uric acid calculi in the elderly patient. Geriatric Nephrol Urol 1, 129–137 (1991). https://doi.org/10.1007/BF00577148
Issue Date:
DOI: https://doi.org/10.1007/BF00577148