Abstract
Objectives
To determine whether the biochemical presentation and urinary physicochemical environment
of patients with hyperuricosuria presenting with calcium stones (hyperuricosuric calcium
urolithiasis [HUCU]) differs from those of patients with gouty diathesis (GD) or idiopathic
uric acid urolithiasis.
Methods
A total of 122 patients with HUCU and 68 patients with GD were identified from our
“stone registry” of patients who underwent a full ambulatory evaluation. All patients
with HUCU had urinary uric acid greater than 800 mg/day in men and greater than 750
mg/day in women and presented with calcium stones. Those with GD had pure uric acid
stones or mixed uric acid-calcium stones and did not have secondary causes of uric
acid urolithiasis. Data derived from the fasting serum and 24-hour urine samples collected
on a random diet and on a diet restricted in calcium, sodium, and oxalate were compared
between the two groups.
Results
Compared with patients with HUCU, those with GD had significantly higher serum uric
acid and lower urinary uric acid and pH levels (mean value 5.38 and 5.35 on random
and restricted diets versus 6.09 and 6.14, respectively). The fractional excretion
of urate and the discriminant score of the relationship between urinary pH and the
fractional excretion of urate were significantly lower in those with GD than in those
with HUCU. Patients with HUCU displayed a greater urinary saturation of sodium urate
and calcium oxalate compared with those with GD, and those with GD had a higher urinary
content of undissociated uric acid and lower urinary saturation of brushite (calcium
phosphate).
Conclusions
Patients with HUCU presented with normal urinary pH and hyperuricosuria, accompanied
sometimes by hypercalciuria, which produced increased urinary saturation of sodium
urate and calcium oxalate. In contrast, those with GD had a low fractional excretion
of urate (that contributed to hyperuricemia) and low urinary pH (that led to increased
amount of undissociated uric acid). The varying biochemical and physicochemical presentations
of the two conditions can be ascribed to overindulgence with purine-rich foods in
those with HUCU and underlying primary gout in those with GD.
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Article info
Publication history
Accepted:
June 18,
2002
Received:
May 3,
2002
Footnotes
☆This work was supported by grants P01-DK20543 and M01-RR00633 from the National Institutes of Health.
Identification
Copyright
© 2002 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
