A case of renal hypouricemia associated with a uric acid bladder stone:Solubility of urinary uric acid crystals and uric acid stones as a standard of alkali therapy

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A 64-year-old male with renal hypouricemia associated with a uric acid bladder stone and benign prostatic hyperplasia is reported. Transurethral prostatectomy and cystolithotripsy was performed. The crystalline component of the stone was uric acid dihydrate by infrared spectrophotometry. Further examination revealed that impaired renal tubular absorption of uric acid was responsible for the hypouricemia in this case.<BR>We studied the solubility of anhydrous uric acid stones, and compared it with that of anhydrous uric acid and urinary uric acid (uric acid dihydrate). As reported previously, the solubility of urinary crystals was 2.1 to 2.9 times higher than that of anhydrous uric acid. However the solubility of uric acid stones was only slightly higher than that of anhydrous uric acid. If uric acid crystals formed in the urine are dihydrate in form and they change to anhydrous form subsequently, uric acid stone formation can be prevented by alkalinization based on the solubility of urinary uric acid crystals. On the other hand, much stronger alkalinization is necessary to dissolve the stones.
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