Uric Acid Stones — ESENeph MCQ

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ModerateRenal Stone DiseaseUric Acid StonesESENeph

A 45-year-old man presents with recurrent uric acid kidney stones. His serum urate is 520 umol/L and 24-hour urine pH is consistently <5.5. He has metabolic syndrome. What is the key measure to prevent further uric acid stones?

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Correct answer: B — Urinary alkalinisation with potassium citrate (target urine pH 6.5-7.0)

Uric acid stones form in persistently acidic urine (pH <5.5). The most effective prevention strategy is urinary alkalinisation with potassium citrate, targeting urine pH 6.5-7.0, which dramatically increases uric acid solubility. Allopurinol reduces serum and urinary uric acid but does not address the fundamental problem of urine acidity. High fluid intake and dietary modification are adjunctive measures. Metabolic syndrome is strongly associated with low urine pH and uric acid stone formation.

Reference: EAU 2024 – Urolithiasis Guidelines