This protocol addresses patients with kidney stone disease in whom the stone is a radiolucent uric acid stone — radiographically invisible on plain X-ray. Stones composed of uric acid, but not sodium or ammonium urate stones, can be dissolved by oral chemolysis, making this subtype distinct in its management pathway.
Management centres on oral chemolysis through urinary alkalinisation. The approach involves patient self-monitoring, with specific agents and pH targets guiding therapy.
Stones composed of uric acid, but not sodium or ammonium urate stones, can be dissolved by oral chemolysis.
Oral chemolysis is based on alkalinisation of urine by application of alkaline citrate or sodium bicarbonate.
The pH should be adjusted to 7.0–7.2.
In the case of uric acid obstruction of the collecting system, oral chemolysis in combination with urinary drainage is indicated.
Combine oral chemolysis with tamsulosin* in case of (larger) ureteral stones (if active intervention is not indicated).