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Related Concept Videos

Urinary Tract Calculi IV: Nutrition Therapy and Prevention01:27

Urinary Tract Calculi IV: Nutrition Therapy and Prevention

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Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
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Urinary Tract Calculi III: Medical Management01:30

Urinary Tract Calculi III: Medical Management

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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
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Urinary Tract Calculi V: Nursing Management01:28

Urinary Tract Calculi V: Nursing Management

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AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
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Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Imaging Studies V: Intravenous Urography and Retrograde Pyelography01:22

Imaging Studies V: Intravenous Urography and Retrograde Pyelography

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IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
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Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations

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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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Quantitative SERS Detection of Uric Acid via Formation of Precise Plasmonic Nanojunctions within Aggregates of Gold Nanoparticles and Cucurbit[n]uril
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Updates in uricase therapy for gout.

Naomi Schlesinger1, Dan Kaufmann2

  • 1Harold J. Ardella T. and Helen T. Stevenson Presidential Chair in Rheumatology, Professor and Chief, Division of Rheumatology.

Current Opinion in Rheumatology
|September 8, 2025
PubMed
Summary

Exogenous uricases are an option for gout patients unresponsive to oral urate-lowering therapy (ULT). Newer uricase therapies aim to reduce flares and infusion reactions by managing immune responses, improving gout treatment outcomes.

Keywords:
PEGylationantidrug antibodiesflaresgouthyperuricemiaimmunomodulationinfusion reactionsuricase

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Area of Science:

  • Rheumatology
  • Pharmacology
  • Immunology

Background:

  • Urate-lowering therapy (ULT) is crucial for gout management.
  • Some patients do not achieve target serum urate levels (< 6.8 mg/dL) with oral ULT.
  • Exogenous uricases offer an alternative for refractory gout cases.

Purpose of the Study:

  • To review available and emerging exogenous uricase therapies for gout.
  • To focus on strategies for mitigating adverse effects like flares and infusion reactions.
  • To discuss the role of immunomodulation and anti-inflammatory prophylaxis.

Main Methods:

  • Literature review of current and investigational uricase treatments.
  • Analysis of mechanisms underlying pegloticase limitations (gout flares, infusion reactions, antidrug antibodies).
  • Exploration of novel uricase formulations and adjunctive therapies.

Main Results:

  • Pegloticase is indicated for uncontrolled gout; rasburicase is for tumor lysis syndrome.
  • Gout flares and infusion reactions with pegloticase are associated with antidrug antibodies.
  • Emerging therapies like NASP and PRX-115 show potential for improved efficacy and tolerability.

Conclusions:

  • Exogenous uricases are valuable for patients with uncontrolled gout.
  • Immunomodulation and anti-inflammatory prophylaxis are key to reducing adverse events.
  • Development of new uricases aims to enhance safety and effectiveness in gout management.