Epidemiology, pathophysiology, and management of uric acid urolithiasis: A narrative review

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Graphical abstract

Quoted from Urolithiasis – EAU Guidelines 2016 with adaptation.

Abstract

An in-depth comprehension of the epidemiology as well as pathophysiology of uric acid urolithiasis is important for the identification, treatment, and prophylaxis of calculi in these patients. Persistently low urinary pH, hyperuricosuria, and low urinary volume are the most important factors in pathogenesis of uric acid urolithiasis. Other various causes of calculus formation comprises of chronic diarrhea, renal hyperuricosuria, insulin resistance, primary gout, extra purine in the diet, neoplastic syndromes, and congenital hyperuricemia. Non-contrast-enhanced computed tomography is the radiologic modality of choice for early assessment of patients with renal colic. Excluding situations where there is acute obstruction, rising blood chemistry, severe infection, or unresolved pain, the initial management ought to be medical dissolution by oral chemolysis since this method has proved to be effective in most of the cases.

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Most cited references 95

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Urologic diseases in America project: urolithiasis.

Margaret Pearle, Elizabeth Calhoun, Gary Curhan (2005)

We quantified the burden of urolithiasis in the United States by identifying trends in the use of health care resources and estimating the economic impact of the disease. The analytical methods used to generate these results have been described previously. The rate of national inpatient hospitalizations for a diagnosis of urolithiasis decreased by 15% and hospital length of stay decreased from 2.6 to 2.2 days between 1994 and 2000. Rates of hospitalization were 2.5 to 3-fold higher for Medicare beneficiaries with little change between 1992 and 1998. Almost 2 million outpatient visits for a primary diagnosis of urolithiasis were recorded in 2000. Hospital outpatient visits increased by 40% between 1994 and 2000 and physician office visits increased by 43% between 1992 and 2000. In the Medicare population hospital outpatient and office visits increased by 29% and 41%, respectively, between 1992 and 1998. The distribution of surgical procedures remained relatively stable through the 1990s. Shock wave lithotripsy was the most commonly performed procedure, followed closely by ureteroscopy. Overall the total estimated annual expenditure for individuals with claims for a diagnosis of urolithiasis was almost $2.1 billion in 2000, representing a 50% increase since 1994. The cost of urolithiasis is estimated at almost $2 billion annually and it appears to be increasing with time despite a shift in inpatient to outpatient treatment and the emergence of minimally invasive treatment modalities, perhaps because the prevalence of stone disease is increasing.

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Loss of urate oxidase activity in hominoids and its evolutionary implications.

Masako Oda, Yoko Satta, Osamu Takenaka … (2002)

We have determined and compared the promoter, coding, and intronic sequences of the urate oxidase (Uox) gene of various primate species. Although we confirm the previous observation that the inactivation of the gene in the clade of the human and the great apes results from a single CGA to TGA nonsense mutation in exon 2, we find that the inactivation in the gibbon lineage results from an independent nonsense mutation at a different CGA codon in exon 2 or from either one-base deletion in exon 3 or one-base insertion in exon 5, contrary to the previous claim that the cause is a 13-bp deletion in exon 2. We also find that compared with other organisms, the primate functional Uox gene is exceptional in terms of usage of CGA codons which are prone to TGA nonsense mutations. Nevertheless, we demonstrate rather strong selective constraint against nonsynonymous sites of the functional Uox gene and argue that this observation is consistent with the fact that the Uox gene is unique in the genome and evolutionarily conserved not only among animals but also among eukaryotes. Another finding that there are a few substitutions in the cis-acting element or CAAT-box (or both) of primate functional Uox genes may explain the lowered transcriptional activity. We suggest that although the inactivation of the hominoid Uox gene was caused by independent nonsense or frameshift mutations, the gene has taken a two-step deterioration process, first in the promoter and second in the coding region during primate evolution. It is also argued that the high concentration of uric acid in the blood of humans and nonhuman primates has developed molecular coevolution with the xanthine oxidoreductase in purine metabolism. However, it remains to be answered whether loss of Uox activity in hominoids is related to protection from oxidative damage and the prolonged life span.

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Randall's plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle.

Marc Grynpas, J Lingeman, Ralf Sommer … (2003)

Our purpose here is to test the hypothesis that Randall's plaques, calcium phosphate deposits in kidneys of patients with calcium renal stones, arise in unique anatomical regions of the kidney, their formation conditioned by specific stone-forming pathophysiologies. To test this hypothesis, we performed intraoperative biopsies of plaques in kidneys of idiopathic-calcium-stone formers and patients with stones due to obesity-related bypass procedures and obtained papillary specimens from non-stone formers after nephrectomy. Plaque originates in the basement membranes of the thin loops of Henle and spreads from there through the interstitium to beneath the urothelium. Patients who have undergone bypass surgery do not produce such plaque but instead form intratubular hydroxyapatite crystals in collecting ducts. Non-stone formers also do not form plaque. Plaque is specific to certain kinds of stone-forming patients and is initiated specifically in thin-limb basement membranes by mechanisms that remain to be elucidated.

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Author and article information

Contributors

A. Abou-Elela

Journal

Journal ID (nlm-ta): J Adv Res

Journal ID (iso-abbrev): J Adv Res

Title: Journal of Advanced Research

Publisher: Elsevier

ISSN (Print): 2090-1232

ISSN (Electronic): 2090-1224

Publication date PMC-release: 28 April 2017

Publication date (Print): September 2017

Publication date (Electronic): 28 April 2017

Volume: 8

Issue: 5

Pages: 513-527

Affiliations

Department Of Urology, Faculty Of Medicine, Cairo University, Kasr Al Ainy St., P.O. 11553, Cairo 11562, Egypt

Article

Publisher ID: S2090-1232(17)30050-4

DOI: 10.1016/j.jare.2017.04.005

PMC ID: 5512151

PubMed ID: 28748117

SO-VID: ae124b9f-9730-4863-b85a-12f0971e2e14

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 11 January 2017

Date revision received : 16 April 2017

Date accepted : 25 April 2017

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