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Uric acid nephrolithiasis — ESENeph MCQ

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HardUrological ConditionsUric acid nephrolithiasisESENeph

A radiolucent uric-acid ureteric stone is being treated by oral chemolysis. There is no obstruction or infection. Which urine-pH target best balances dissolution against calcium-phosphate precipitation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Titrate citrate or bicarbonate to urine pH 7.0–7.2 with home testing

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

B is correct. Uric-acid stones can be dissolved with oral citrate or sodium bicarbonate when obstruction and infection have been addressed. EAU guidance targets urine pH 7.0–7.2 for chemolysis, with frequent patient monitoring and dose adjustment. Persistently acidic urine prevents adequate urate ionisation, while pushing pH substantially higher increases calcium-phosphate precipitation risk. Allopurinol may be appropriate for hyperuricosuria or gout but does not replace alkalinisation for dissolution of an existing pure uric-acid stone. Hydration and imaging follow-up remain necessary to document response.

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