Uric Acid Stones

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Generally, uric acid renal stones are likely to form in the following circumstances: (1) increased excretion

Crohn Disease Skin
Fig. 1. Bilaterally dilated renal calices, renal and ureteral calculi (white arrows) and calcifications (black arrow) in a patient with longstanding CD

of uric acid in the urine, (2) persistently concentrated urine, (3) persistently low urinary pH. The last two conditions are often present in IBD patients; in fact, chronic diarrhoea secondary to UC or to an ileosto-my generates a loss of water, sodium and bicarbonate salt, which are able to concentrate the urine and lower its pH.

Clarke et al. [16] noticed that people with ileosto-my produced about 300 ml less urine in a day than the control population; moreover the mean urinary pH was 5.05. At these levels, the solubility of uric acid (which has a pKa of 5.7) is almost 12 times lower [10], and this predisposes to crystallization and formation of uric stones, even in the absence of hyperuricemia and hyperuricosuria [17]. Other circumstances like urinary tract infection, chronic ureteral obstruction, high urinary calcium and oxalate concentration, steroid use (because they increase intestinal calcium absorption), prolonged bed rest (which favours calcium mobilisation from the bones), all increase the chance of stone formation.

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