December 1, 2022

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What causes gouty kidney stones?

What causes gouty kidney stones?


What causes gouty kidney stones? The proportion of kidney involvement in gout patients is relatively high, and 100% of kidney damage caused by gout has been clinically confirmed.

The proportion of kidney involvement in gout patients is relatively high, and 100% of kidney damage caused by gout has been clinically confirmed. The first and main clinical manifestation of gout patients is renal uric acid stones.

What causes gouty kidney stones?

 


1. How do gouty kidney stones form?

Gouty kidney stones, also known as uric acid kidney stones, are a special kind of gout stones. The incidence of kidney stones in gout patients is about 35%-40%, which is 200 times that of normal people. So, what is the cause of gouty kidney stones?

  • Persistent aciduria.
  • Acidic urine is a characteristic of patients with uric acid stones, and the urine pH is usually lower than 6.0, usually fixed at 5.0.
  • Insufficient urine output.
  • Patients with uric acid stones tend to have less urine.
  • Hyperuricemia.

There are many reasons for hyperuricemia, such as excessive intake of purine precursors, increased synthesis of endogenous uric acid, and decreased renal reabsorption. Obesity and alcoholism can also cause excessive purine production and hyperuricemia.

 

2. What are the abnormal symptoms and signs of urinary stones?

Small-diameter stones and large stones, such as kidney calyx antler-shaped stones, do not cause ureteral obstruction, so they often have no symptoms and occasionally cause low back pain and other discomfort.

The most frightening thing is bilateral asymptomatic obstructive stones, which often go to the hospital due to renal insufficiency or even uremia. These asymptomatic stones are often found accidentally due to physical examination or other diseases, so regular physical examination is very important.

When passing through the ureter, medium-sized stones will get stuck in the ureter, causing typical renal colic, which is manifested by sudden severe pain on the side and abdomen, which radiates to the front and inside of the body for a short duration. About 50% of patients with renal colic will experience nausea and vomiting at the same time.


If the above conditions are not suitable for timely medical treatment, most of the stones can be diagnosed by urinary b-ultrasound. If necessary, abdominal X-ray or CT is required to confirm the diagnosis.

 

3. How to treat tophi?

The treatment of stones is related to their location, nature, size and complications.

Treatment can be divided into two stages, acute and normal treatment.


Acute patients such as renal colic, urinary tract infection or urinary tract obstruction should be treated immediately. For renal colic, ibuprofen and other analgesics can be used. If the pain cannot be controlled, a strong analgesic is needed. For urinary tract infections, active anti-infective treatment should be given. Of course, the specific situation should be carried out under the guidance of professional doctors.
Common treatments include the use of lithotripsy and stone-dissolving drugs. The effect of dissolving uric acid stones is ideal, and the success rate is close to 80%~90%. Indeed, for uric acid stones without pain, infection, and urinary tract obstruction, drugs can be used to alkalize urine to dissolve the stones.

Note: One of the main contraindications that benzbromarone can increase uric acid excretion is kidney stones. Its uric acid lowering effect is mainly achieved by increasing the excretion of uric acid in the kidneys, so it will increase the possibility of kidney stones. If you already have kidney stones, benzbromarone is generally not suitable.

 

4. How to prevent the recurrence of gout stones?

The ten-year recurrence rate of urinary stones can reach 52%, and various measures need to be taken to prevent recurrence.

  •  Drink plenty of water: drink at least 2000ml (equivalent to a thermos) every day to ensure that the daily urine output is above 2000ml;
  • Moderate exercise: It is helpful to discharge tiny stones, but it is necessary to prevent dehydration and urine concentration caused by excessive exercise;
  • Weight control: Obesity easily leads to the formation of stones, obese people should lose weight;
  • Restrict food: cockroaches are the precursor of uric acid. Therefore, meat, fish, shrimp and other foods rich in cockroaches should be strictly restricted, and the total daily amount should not exceed 150 grams; avoid eating animal offal; eat less soy products and mushrooms;
  • First choice foods: low-content foods should be eaten, such as rice, noodles, eggs, milk, vegetables, fruits, etc.;
  • Alkalizing urine: uric acid stones are easily formed in acidic urine. Alkalizing urine is conducive to the autolysis of stones. Citrus fruits rich in potassium citrate (an alkalizing agent) can be eaten regularly;
  • Strictly abstain from alcohol: drinking is not suitable. Alcohol increases the excretion of lactic acid in the urine and causes acidification of the urine. In addition, drinking beer will produce a lot of uric acid in the urine, leading to recurrence of stones;
  • Regular physical examination: check b-ultrasound, uric acid and urinary system uric acid regularly every six months.

 

(source:internet, reference only)


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