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Pathophysiologic basis for normouricosuric uric acid nephrolithiasis.

Khashayar Sakhaee1, Beverley Adams-Huet, Orson W Moe

  • 1Center of Mineral Metabolism and Clinical Research, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8891, USA.

Kidney International
|August 8, 2002
PubMed
Summary
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Patients with uric acid stones have impaired kidney function, leading to lower urinary pH and increased risk of stone formation. This defect in ammonium excretion may be linked to insulin resistance.

Area of Science:

  • Nephrology
  • Urology
  • Endocrinology

Background:

  • Low urinary pH is a primary factor in uric acid nephrolithiasis.
  • The underlying cause of this urinary acidification defect remains unknown.
  • Patients with uric acid stones often present with normal clinical acid-base parameters.

Purpose of the Study:

  • To investigate the acid-base balance and ammonium excretion in patients with pure uric acid stones.
  • To compare these parameters with those of patients with mixed stones, calcium stones, and healthy individuals.

Main Methods:

  • Studied steady-state plasma and urinary acid-base parameters.
  • Assessed renal ammonium excretion response to an acute acid load.
  • Compared stone formers with controls and different stone compositions.
Keywords:
Non-programmatic

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Main Results:

  • Uric acid stone formers exhibit lower urinary pH and reduced ammonium excretion.
  • These patients show a higher incidence of diabetes or glucose intolerance.
  • Impaired ammonia excretion leads to further urine acidification after an acid load.

Conclusions:

  • A subset of patients with uric acid nephrolithiasis may have a renal acidification disease.
  • The primary defect appears to be impaired renal ammonium excretion, potentially linked to insulin resistance.
  • This leads to acidic urine pH, contributing to uric acid nephrolithiasis.