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Treatment of calcium nephrolithiasis in the patient with hyperuricosuria

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Abstract

Nearly one-third of patients with calcium stones have hyperuricosuria. In vitro studies and clinical trials have investigated the relationship between uric acid and calcium stones, but the association between hyperuricosuria and calcium stone formation in patients is still being debated. Uric acid appears to cause salting out of calcium oxalate in human urine. However, the importance of this in vitro phenomenon to the proposed association is not supported in cross-sectional observational studies. A small placebo-controlled randomized clinical trial showed that allopurinol decreased the rate of recurrent calcium oxalate calculi in patients with hyperuricosuria and normocalciuria. An assessment of the effect of combination therapy of allopurinol with indapamide showed no additive effect. Allopurinol may have antioxidant effects that are responsible for its reducing calcium stone formation, which are independent of xanthine oxidase inhibition. In addition, a newer xanthine oxidoreductase inhibitor, febuxostat, may also be effective in the prevention of calcium stones, as it reduces urinary uric acid excretion.

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Conflict of interest

Arowojolu: none; Goldfarb: consultant, Takeda, Astra Zeneca; owner, Ravine Group; Honoraria: Mission Pharmacal.

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Authors and Affiliations

  1. Medicine and Physiology, NYU School of Medicine, New York, NY, USA

    Omotayo Arowojolu & David S. Goldfarb

  2. Nephrology Section, New York Harbor VA Healthcare System and NYU Langone Medical Center, NYU School of Medicine, 111G New York DVAMC 423 E. 23 St., New York, NY, 10010, USA

    David S. Goldfarb

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  1. Omotayo Arowojolu
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  2. David S. Goldfarb
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Correspondence to David S. Goldfarb.

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Arowojolu, O., Goldfarb, D.S. Treatment of calcium nephrolithiasis in the patient with hyperuricosuria. J Nephrol 27, 601–605 (2014). https://doi.org/10.1007/s40620-014-0084-x

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  • DOI: https://doi.org/10.1007/s40620-014-0084-x

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