title: Treatment of calcium nephrolithiasis in the patient with hyperuricosuria.
abstract: Nearly one-third of patients with calcium stones have hyperuricosuria. In vitro studies and clinical trials have investigated the relationship between uric acid and calcium stones, but the association between hyperuricosuria and calcium stone formation in patients is still being debated. Uric acid appears to cause salting out of calcium oxalate in human urine. However, the importance of this in vitro phenomenon to the proposed association is not supported in cross-sectional observational studies. A small placebo-controlled randomized clinical trial showed that allopurinol decreased the rate of recurrent calcium oxalate calculi in patients with hyperuricosuria and normocalciuria. An assessment of the effect of combination therapy of allopurinol with indapamide showed no additive effect. Allopurinol may have antioxidant effects that are responsible for its reducing calcium stone formation, which are independent of xanthine oxidase inhibition. In addition, a newer xanthine oxidoreductase inhibitor, febuxostat, may also be effective in the prevention of calcium stones, as it reduces urinary uric acid excretion.
authors.affiliation: Medicine and Physiology, NYU School of Medicine, New York, NY, USA.
authors.forename: Omotayo
authors.initials: O
authors.lastname: Arowojolu
authors.affiliation: Medicine and Physiology, NYU School of Medicine, New York, NY, USA. dsgold@verizon.net.|Nephrology Section, New York Harbor VA Healthcare System and NYU Langone Medical Center, NYU School of Medicine, 111G New York DVAMC 423 E. 23 St., New York, NY, 10010, USA. dsgold@verizon.net.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine*; D002129:Calcium Oxalate / Q000652:urine*; D000069465:Febuxostat / Q000627:therapeutic use; D006801:Humans; D007190:Indapamide / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D053040:Nephrolithiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D012307:Risk Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000652:urine*; D014528:Uricosuric Agents / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D014528:Uricosuric Agents; D000069465:Febuxostat; D002129:Calcium Oxalate; D014527:Uric Acid; D000493:Allopurinol; D007190:Indapamide
keywords: Allopurinol; Calcium; Calculi, renal; Febuxostat; Kidney stones; Nephrolithiasis; Uric acid; Urolithiasis