APRT Deficiency DHA Stones Purine Metabolism — ESENeph MCQ

Correct answer: B — Oral urinary alkalinisation with citrate or bicarbonate

The best answer is “Oral urinary alkalinisation with citrate or bicarbonate”. Uric acid solubility increases as urine is alkalinised, so citrate or bicarbonate can provide oral chemolysis. Urine pH is self-monitored because excessive alkalinisation promotes calcium-phosphate stones; obstruction or infection changes management. “Acidify urine with ammonium chloride” is less appropriate because uric acid becomes less soluble as urine pH falls “Give antibiotics despite sterile urine” is less appropriate because uric-acid crystallisation is metabolic rather than an infection-stone process “Use calcium supplements to bind urinary urate” is less appropriate because calcium does not provide chemolysis and can add calcium-stone risk “Use alpha blockade as the chemical dissolving agent” is less appropriate because alpha blockers may assist ureteric passage but do not dissolve uric acid

Reference: EAU urolithiasis metabolic evaluation guideline: https://uroweb.org/guidelines/urolithiasis/chapter/metabolic-evaluation-and-recurrence-prevention