<p><strong>In adult and pediatric patients with uric acid stones, clinicians should offer alkali therapy to raise urinary pH. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>Uric acid stones form primarily in an acidic urinary environment due to the poor solubility of urate when urinary pH drops below 5.5. Accordingly, urinary alkalinization is the cornerstone of dissolution and prevention of uric acid stones.<sup>204</sup> Potassium alkali (e.g., potassium citrate) is preferred over sodium alkali (e.g., sodium bicarbonate) because potassium urate is more soluble than sodium urate.<sup>205</sup> Potassium alkali is also less likely to cause hypertensive side effects associated with a sodium load. On the other hand, low potassium or no potassium preparations may be considered to achieve therapeutic urinary pH and/or citrate levels in patients with hyperkalemia or who develop hyperkalemia on potassium-based preparation.</p>
<p>In retrospective single-center studies, raising urinary pH with alkali therapy for three months led to dissolution of existing uric acid stones<sup>206</sup> and prevented recurrent stone passage in the long-term.<sup>207</sup> In addition to its efficacy in dissolving uric acid stones, alkali therapy reduces the need for stone surgery.<sup>208</sup> For patients who form uric acid stones, the Panel recommends titrating alkali therapy to achieve a urinary pH between 6.5-7.0 to dissolve existing stones and to maintain a urinary pH between 6.0-6.5 to prevent uric acid stone recurrence.</p>