eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Uric Acid Stones: Follow-up

Author: Sahar Fathallah-Shaykh, MD, Assistant Professor in Pediatric Nephrology, Northwestern University Feinberg School of Medicine; Consulting Staff, Division of Kidney Diseases, Children's Memorial Hospital
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
Contributor Information and Disclosures

Updated: Jul 8, 2008

Follow-up

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.

Inpatient & Outpatient Medications

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

Deterrence/Prevention

  • 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:

Prognosis

  • 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.

Patient Education

  • 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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis in a patient with renal colic and evidence of a radiolucent stone or markedly elevated serum uric acid concentration and reduced renal function may lead to renal failure.

Special Concerns

  • Infants and young children may have nonspecific symptoms (eg, emesis, irritability, anorexia, poor weight gain, hematuria) related to uric acid stones.
 


More on Uric Acid Stones

Overview: Uric Acid Stones
Differential Diagnoses & Workup: Uric Acid Stones
Treatment & Medication: Uric Acid Stones
Follow-up: Uric Acid Stones
Multimedia: Uric Acid Stones
References
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References

  1. Baldree LA, Stapleton FB. Uric acid metabolism in children. Pediatr Clin North Am. Apr 1990;37(2):391-418. [Medline].

  2. 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].

  3. Sakhaee K, Maalouf NM. Metabolic syndrome and uric acid nephrolithiasis. Semin Nephrol. Mar 2008;28(2):174-80. [Medline].

  4. 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].

  5. Barrat TM, PG Duffy. Nephrocalcinosis and Urolithiasis. In: Pediatric Nephrology. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:933-46.

  6. Camron JS, F Moro. Gout, Uric Acid, and Purine Metabolism in Pediatric Nephrology. In: Pediatric Nephrology. Vol 7. 1993:105-18.

  7. 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].

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Further Reading

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Keywords

uric acid stones, radiolucent kidney stones, gouty nephropathy, urate nephropathy, uric acid urolithiasis, uric acid kidney stones, renal insufficiency, uric acid urolithiasis, renal stones, glycogen-storage disease, gross hematuria, leukemia, lymphoma, lung cancer, breast cancer, pancreatic cancer, hyperuricosuria, hypouricemia, familial juvenile gouty nephropathy, renal failure, urinary tract obstruction, insomnia, Lesch-Nyhan syndrome, tumor lysis disease, gout, polycythemia, lead exposure, congestive heart failure, sarcoidosis, purine disorder, laxative abuse, hypoxanthine-guanine phosphoribosyltransferase deficiency, HGPRT deficiency, phosphoribosyl pyrophosphate synthetase, PRPP synthetase, glucose-6-phosphatase deficiency, myeloproliferative disorder, lymphoproliferative disorder

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Contributor Information and Disclosures

Author

Sahar Fathallah-Shaykh, MD, Assistant Professor in Pediatric Nephrology, Northwestern University Feinberg School of Medicine; Consulting Staff, Division of Kidney Diseases, Children's Memorial Hospital
Sahar Fathallah-Shaykh, MD is a member of the following medical societies: American Society of 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

Medical Editor

Uri S Alon, MD, Director of Research and Education, Department of Pediatrics, Division of Pediatric Nephrology, Children's Mercy Hospital of Kansas City; Professor, University of Missouri at Kansas City
Uri S Alon, MD is a member of the following medical societies: American Federation for Medical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
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: Amgen Grant/research funds None; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

 
 
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