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ORIGINAL ARTICLE

Medical dissolution therapy for the treatment of uric acid nephrolithiasis Chad M. Gridley1 · Michael W. Sourial1 · Amy Lehman2 · Bodo E. Knudsen1  Received: 7 November 2018 / Accepted: 18 February 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019

Abstract Introduction  Uric acid (UA) nephrolithiasis represents 10% of kidney stones in the US with low urine pH and high saturation of UA as the main risk factors for stone development. Dissolution therapy for UA kidney stones via urinary alkalization has been described as a treatment option. We present our experience in treating UA nephrolithiasis with medical dissolution therapy. Methods  A retrospective review was performed of UA stone patients referred for surgery but treated with dissolution therapy between July 2007 and July 2016. Patients were identified using ICD-9 codes. Patients were treated with potassium citrate alone or in combination with allopurinol. Serial imaging and urine pH were obtained at follow-up. Demographics, aggregate stone size, time to stone clearance, urine pH (office dip), and complications were recorded. Results obtained  Twenty-four patients (14 men and 10 women) were identified that started medical dissolution therapy for UA nephrolithiasis after initial referral for surgical management. Three patients (13%) did not tolerate the initiation of dissolution therapy and discontinued this treatment. Of the 21 patients that were maintained on dissolution therapy, 14 patients (67%) showed complete resolution of nephrolithiasis and 7 patients (33%) showed partial reduction. Patients with partial response had a mean reduction in stone burden of 68%. There were 3 recorded complications (UTI, GI upset with therapy, and throat irritation) and 4 recorded stone recurrences among these 21 patients. Conclusion  Based on our study population, medical dissolution therapy is a well-tolerated, non-invasive option for UA nephrolithiasis. Keywords  Uric acid · Nephrolithiasis · Dissolution · Alkalization Abbreviations AUA​ American Urological Association BMI Body Mass Index CT Computed tomography GI Gastrointestinal KUB Kidney, ureter, and bladder X-ray RUS Renal ultrasound SD Standard deviation UA Uric acid UTI Urinary tract infection

* Bodo E. Knudsen [email protected] 1



Department of Urology, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA



Center for Biostatistics, The Ohio State University, Columbus, OH, USA

2

Introduction The incidence of stone disease in the US continues to rise with recent reports suggesting up to 1 in 11 people will develop a stone [1]. While most kidney stones have a calcium component, up to 12% of the patients will present with a uric acid (UA) component and nearly 10% of the stones are pure UA [2]. Uric acid kidney stone formation is dependent upon three urinary abnormalities: low urine pH, low urine volume, and elevated urine UA, with low urine pH the highest promoter of stone formation [3]. Several conditions have been a