Uric Acid Stones Clinical Presentation

Updated: Aug 31, 2023
  • Author: Sahar Fathallah-Shaykh, MD; Chief Editor: Craig B Langman, MD  more...
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When obtaining the history, attempt to identify factors associated with hyperuricosuria such as the following:

  • Lesch-Nyhan syndrome

  • Familial gout

  • Uricosuric medications

  • Renal insufficiency

  • Malignancy

  • Hemolysis

  • Lead exposure

  • Purine disorders

  • Sarcoidosis

  • Glycogen-storage disease type I

  • Laxative abuse in females with anorexia nervosa [9]

  • Rotavirus-associated gastroenteritis

  • Vesicourethral reflux [10]

Infants with urate crystalluria may have pink-to-orange areas in their diapers after urination. If Serratia marcescens is also present, the diaper may appear red.


Physical Examination

Renal stones, particularly in the upper urinary tract, cause pain, costovertebral angle tenderness, or both. The manifestations of pain are expressed differently in infants than in teenagers. Hematuria is most often present. Fever, nausea, and vomiting occur. Urinary tract infection may be present.

No physical findings are sensitive or specific for uric acid urolithiasis.

Children with inherited disorders such as trisomy 21, glycogen-storage disease, or Lesch-Nyhan syndrome may have physical findings consistent with their inherited disease.

Children with malignancy may have findings such as lymphadenopathy, hepatosplenomegaly, or paleness secondary to anemia.

Tophi (urate deposits) may be present.