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Potassium Citrate Uric Acid Stones — ESENeph MCQ

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ModerateRenal Stone DiseasePotassium Citrate Uric Acid StonesESENeph

A 48-year-old man presents with acute flank pain and haematuria. CT KUB shows a 5 mm radiolucent stone in the left proximal ureter. Urine pH is 5.0. He has a history of gout and metabolic syndrome. Serum urate is 520 umol/L. What is the most appropriate medical management to prevent recurrence?

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Correct answer: E — Potassium citrate for urine alkalinisation

Radiolucent stones with low urine pH in the context of gout and metabolic syndrome are almost certainly uric acid stones. The cornerstone of uric acid stone prevention is urine alkalinisation to target pH 6.5-7.0, which dramatically increases uric acid solubility. Potassium citrate is preferred over sodium bicarbonate because sodium loading increases calcium excretion and may promote calcium stone formation. Potassium citrate also replaces potassium if there is concomitant diuretic use. Allopurinol may be added if urine alkalinisation alone is insufficient or if hyperuricosuria persists.

Reference: EAU 2023 – Urolithiasis Guidelines; Maalouf et al 2010 – Uric Acid Nephrolithiasis