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Uric Acid Nephrolithiasis — RACP Adult Medicine MCQ

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ModerateNephrologyUric Acid NephrolithiasisRACP Adult Medicine

A 35-year-old man with recurrent uric acid kidney stones presents for prevention advice. His 24-hour urine pH is 5.0 and uric acid excretion is elevated. He has gout and a BMI of 35 kg/m². Serum urate is 0.55 mmol/L. What is the most appropriate preventive therapy?

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Correct answer: A — Potassium citrate

Uric acid stones form in acidic urine (pH <5.5). Urinary alkalinisation with potassium citrate (target urine pH 6.0–7.0) is the most effective prevention strategy, as uric acid is highly soluble at pH >6.0. Allopurinol is added if hyperuricosuria persists despite alkalinisation. Weight loss and dietary modification (reduce purine intake) are also important.

Reference: KHA-CARI – 2024 – Kidney Stone Prevention; eTG Nephrology 2024