The prevalence of
urolithiasis has been increasing for the past few decades in industrialized nations.
Uric acid calculi account for a significant percentage of
urinary stones. Certain risk factors may be involved in the pathogenesis of
uric acid nephrolithiasis, including hyperuricosuria, low urinary volume, and persistently low urinary pH. Patients with medical conditions that promote profound hyperuricosuria are at high risk of developing
uric acid calculi. These conditions include chronic diarrheal states;
myeloproliferative disorders;
insulin resistance, including
diabetes mellitus; and monogenic metabolic disorders, such as
Lesch-Nyhan syndrome. Computed tomography can provide a definitive diagnosis. Except in cases in which there is severe obstruction, progressive
azotemia, serious
infection, or unremitting
pain, the initial treatment of patients with
uric acid nephrolithiasis should be medical dissolution
therapy because this approach is successful in the majority of cases. A thorough review of the epidemiology and pathophysiology of
uric acid nephrolithiasis is crucial for the diagnosis, treatment, and prevention of stones in patients with this condition.