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Uric acid stones, clinical manifestations and therapeutic considerations
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  • Published on: 12 July 2018
    A point of view: Diuretics and many dietary components significantly increase the risk of uric acid stone formation--Our major concern
    • Jogenananda Pramanik MBBS.MD, Professor & Dean Careers Abroad Institute School of Medicine
    • Other Contributors:
      • Satish Gunwant MBBS MS FRCS, Consultant Uro-Surgeon

    A point of view:
    Diuretics and many dietary components significantly increase the risk of uric acid stone formation--Our major concern.
    We read with interest and applauded the authors of the review article that mentions adjustment of potential pathophysiologic defects by pharmacotherapy and strongly recommends dietary modification for the prevention of uric stone recurrence (1).
    Two thirds of urate excretion occurs at the kidney, the remainder being excreted by the gut. Earlier studies have suggested that the urate is almost fully reabsorbed and that the urate excreted by the kidney is the result of tubular secretion. But more recent data suggests that secretion plays little part, and that excreted urate largely represents the filtered urate which escapes reabsorption. (2)
    Different diuretics are likely to have different effects on the renal handling of urate, but this has not been critically ascertained; patients receiving more powerful loop diuretics have a higher risk of developing gout than those receiving the weaker thiazides (3)
    Conceptually, a visit to a beer garden is dangerous for two reasons, the intake of purine rich food and drinks (beer) and the intake of fructose-rich soft drinks that blocks certain urate transporters that facilitate urate excretion (4).
    These are also associated with a number of common situations, such as the metabolic syndrome, which is correctable by changing to a low caloric diet, essential hypertensio...

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    Conflict of Interest:
    None declared.