Uric Acid Stones Follow-up

Author: Sahar Fathallah-Shaykh, MD; Chief Editor: Craig B Langman, MD more...

Updated: Aug 3, 2011

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Further Inpatient Care
Further Outpatient Care
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Further Inpatient Care

Inpatient care is indicated for management of renal failure, urologic surgery, severe pain, infection, or obstruction.

Further Outpatient Care

The child should continue a low-purine diet if prescribed.

Continue Bicitra (2-6 mEq/kg/d) for urinary alkalinization.
Parents can be provided urine dipsticks to monitor urine pH level and specific gravity to assess the adequacy of treatment. Urine pH levels should be maintained above 7. Urine specific gravity should be maintained below 1.01.
Fluid intake should be sufficient to maintain urine output of 30 mL/kg/24h or more.
Allopurinol is continued to lower uric acid production if prescribed.

Children with urinary tract uric acid stones and/or urinary tract anatomic abnormalities or a previous urinary tract infection may require urinary tract infection uroprophylaxis.

A low-purine diet, allopurinol, Bicitra, and aggressive hydration should be continued. The goals are to dissolve present stones and to prevent new stones.

A low-purine diet, urinary alkalinization, and large fluid intake may prevent new stones from forming.

Complications

Complications of renal stone disease include the following:

Bleeding
Obstruction
Infection
Pain
Complications of acute renal failure (ie, hypertension, hyperkalemia, pulmonary edema)

The prognosis depends on the primary disease process. Children with cancer and Lesch-Nyhan syndrome tend to do worse than children with isolated HGPRT defects.

Inform patients about the specific disease process when possible.
Discuss the importance of diet, medication, and fluid intake in preventing new stone formation.
Indicate the importance of physician reevaluation if the child develops fever, pain, vomiting, dehydration, renal colic, or gross hematuria.
For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Kidney Stones.

Contributor Information and Disclosures

Author

Sahar Fathallah-Shaykh, MD Assistant Professor in Pediatric Nephrology, University of Alabama at Birmingham School of Medicine; Consulting Staff, Division of Pediatric Nephrology, Medical Director of Pediatric Dialysis Unit, Children's of Alabama

Sahar Fathallah-Shaykh, MD is a member of the following medical societies: American Society of Nephrology and American Society of Pediatric Nephrology

Disclosure: emedecine Honoraria Other

Coauthor(s)

Richard Neiberger, MD, PhD Director of Pediatric Renal Stone Disease Clinic, Associate Professor, Department of Pediatrics, Division of Nephrology, University of Florida College of Medicine and Shands Hospital

Richard Neiberger, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Medical Association, American Society of Nephrology, American Society of Pediatric Nephrology, Christian Medical & Dental Society, Florida Medical Association, International Society for Peritoneal Dialysis, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Shock Society, Sigma Xi, Southern Medical Association, Southern Society for Pediatric Research, and Southwest Pediatric Nephrology Study Group

Disclosure: The Osler Institute Honoraria Speaking and teaching

Specialty Editor Board

Uri S Alon, MD Director of Bone and Mineral Disorders Clinic and Renal Research Laboratory, Children's Mercy Hospital of Kansas City; Professor, Department of Pediatrics, Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine

Uri S Alon, MD is a member of the following medical societies: American Federation for Medical Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Frederick J Kaskel, MD, PhD Director of the Division and Training Program in Pediatric Nephrology, Vice Chair, Department of Pediatrics, Montefiore Medical Center and Albert Einstein School of Medicine

Frederick J Kaskel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Physiological Society, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, Eastern Society for Pediatric Research, Federation of American Societies for Experimental Biology, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Renal Physicians Association, Sigma Xi, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Howard Trachtman, MD Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine

Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD The Isaac A Abt, MD, Professor of Kidney Diseases, Northwestern University, The Feinberg School of Medicine; Division Head of Kidney Diseases, Children's Memorial Hospital

Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology

Disclosure: Merck Grant/research funds None; NIH Grant/research funds None; Raptor Pharmaceuticals, Inc Grant/research funds None; Alexion Pharmaceuticals, Inc. Grant/research funds None

References

Baldree LA, Stapleton FB. Uric acid metabolism in children. Pediatr Clin North Am. Apr 1990;37(2):391-418. [Medline].
Fujita T, Shimooka T, Teraoka Y, Sugita Y, Kaito H, Iijima K, et al. Acute renal failure due to obstructive uric acid stones associated with acute gastroenteritis. Pediatr Nephrol. Dec 2009;24(12):2467-9. [Medline].
Kaneko K, Shimo T, Hirabayashi M, Ito T, Okazaki H, Harada Y. Cause of uric acid stones in rotavirus-associated gastroenteritis. Pediatr Nephrol. Oct 2010;25(10):2187-8. [Medline].
Kato K, Sai S, Hirata T, et al. Two cases of ammonium acid urate urinary stones related to anorexia nervosa and laxative abuse. Hinyokika Kiyo.Mar. 2004;50(3):181-5. [Medline].
Sakhaee K, Maalouf NM. Metabolic syndrome and uric acid nephrolithiasis. Semin Nephrol. Mar 2008;28(2):174-80. [Medline].
Raj GV, Auge BK, Assimos D, Preminger GM. Metabolic abnormalities associated with renal calculi in patients with horseshoe kidneys. J Endourol. Mar 2004;18(2):157-61. [Medline].
[Medline].
Barrat TM, PG Duffy. Nephrocalcinosis and Urolithiasis. In: Pediatric Nephrology. 4^th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:933-46.
Camron JS, F Moro. Gout, Uric Acid, and Purine Metabolism in Pediatric Nephrology. In: Pediatric Nephrology. Vol 7. 1993:105-18.
Johnson RJ, Kivlighn SD, Kim YG, et al. Reappraisal of the pathogenesis and consequences of hyperuricemia in hypertension, cardiovascular disease, and renal disease. Am J Kidney Dis. Feb 1999;33(2):225-34. [Medline].

Uric acid stones.

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Table 1. Serum Uric Acid levels and Urinary Acid Excretion in Neonates, Children, and Adults [1]

Table 1. Serum Uric Acid levels and Urinary Acid Excretion in Neonates, Children, and Adults^[1]

	Neonates*			Children						Adults
	29-33 wk	34-37 wk	38-40 wk	3-4 y		5-9 y		10-14 y		40-44 y
				Male	Female	Male	Female	Male	Female	Male	Female
Serum uric acid (mg/dL)	7.71±2.65	6.04±2.19	5.19±1.57	3.45±1.01	3.44±0.8	3.63±1.04	3.71±0.92	4.28±1.19	4.09±1.2	5.134±1.25	4.25±1.1
Uric acid excretion (mg/dL GFR^†)	4.8±2.23	2.81±0.93	1.69±0.84	0.34±0.11						0.403±0.095
Uric acid excretion (mg/kg/d)	N/A	N/A	19.6	13.5±3.75 (3 y)		11.5±3.75 (7 y)		9±3.75 (12 y)		10
Fractional excretion of uric acid (%)	61.24±12.21	44.52±15.23	38.19±13.61	12±3.75 (3 y)		10±3 (7 y)		7.6±3.75 (12 y)		7±1.6
*Gestational ages ^† Glomerular filtration rate

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Read more about Uric Acid Stones on Medscape

Uric Acid Stones Follow-up

Further Inpatient Care

Further Outpatient Care

Inpatient & Outpatient Medications

Deterrence/Prevention

Complications

Prognosis

Patient Education