Muhammad Nazir, Imtiaz Akhtar Bajwa, Muhammad Anees, Shamsul Islam, Junaid Habib Khan, Zahoor Ahmad, Muhammad Nawaz Chughtai.
Medical management of uric acid renal calculi.
J Fatima Jinnah Med Coll Lahore Jan ;1(3-4):44-6.

Objective: To asses the efficacy and safety of managing uric acid renal calculi by medical management. Design: An observational prospective study. Place and duration of study: The study was performed in the Department of Urology at Services Hospital Lahore, from December 1999 to December 2002. Patients and methods: Fifty patients irrespective of age and sex, having radiolucent kidney stones were included in this study. Patients were evaluated by detailed history thorough examination, laboratory and radiological investigations. Patients having renal failure, or severe symptomatic urinary tract infection were excluded from the study. All patients were managed by giving 5-10 ml of diluted sodium acid citrate as disodium hydrogen citrate 1.315gm/5ml three times a day. Urinary ph was maintained and monitored between 6.2 to 6.8 by the patients. Patients having hyperuricosuria or hyperuriciemia were given Alopurinol 100- 300 mg per day. Patients were followed up at monthly interval for three months. Results: There were 36 (72%) male and 14 (36%) female. Age range was 20 to 65 with the mean age of 42.5 years. Stone size varied from 1.6cm to 2.9 cm with mean size of 2.1 cm. Hyperuricuria, was found in 11(22%) while 7(14%) patients showed hyperuricimia. Urinary pH was between 4.5 to 5.0 in 32 (64%) and 5.1 to 5.5 in 12 (24%), and in rest of the 6 (12%) patients it was more than 6. After one month of the therapy stone dissolution seen in 4 (8%) pts. This response was increased to 40% at two months and up to 72% at the end of three months therapy. Eight (I6%) patients did not respond to oral chemolytic therapy while in 6 (12%) patients the respons was partial. Stone analysis showed that, these were uric acid stones in 36 (72%) patients and in remaining 14 (28%) patients the uric acid component was more than 50%.Conclusion: Oral chemolytic therapy is a useful tool for managing uric acid renal calculi. We concluded that the medical management should be considered as the first line of treatment in uncomplicated uric acid renal stones.

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