Management of Uric Acid Kidney Stones

Treatment Approach

• The European League Against Rheumatism recommends allopurinol as first-line urate-lowering therapy (ULT) for patients with hyperuricosuria and recurrent uric acid stones, with dosage adjustment based on creatinine clearance for patients with renal impairment 1, 2
• The American College of Rheumatology recommends colchicine for acute gout flares (within 12 hours of onset) and for prophylaxis against gout flares during the first 6 months of urate-lowering therapy 1, 2, 3, 4

Safety Considerations

• The European League Against Rheumatism recommends avoiding colchicine in patients with severe renal impairment 1, 2
• The European League Against Rheumatism recommends not giving colchicine to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors such as cyclosporin or clarithromycin 1, 3

Comprehensive Management

• The American College of Rheumatology recommends screening for associated comorbidities including gout, diabetes, metabolic syndrome, and cardiovascular risk factors in patients with uric acid stones 5
• The European League Against Rheumatism recommends treating gout according to established guidelines (which may include colchicine for acute flares) and treating uric acid stones with urinary alkalinization and increased fluid intake in patients with both gout and uric acid stones 1, 2
• The American Journal of Kidney Diseases recommends considering urate-lowering therapy if indicated in patients with uric acid stones 6, 7