What are your management strategies for patients with recurrent uric acid nephrolithiasis and chronic kidney disease who have persistent hypocitraturia and acidic urine pH?

This is a good question. The primary goal is to correct the urine pH to at least 6 and preferably 6.5, regardless of renal function. Hypocitraturia is not a critical issue in uric acid stones disease, though it will likely respond to therapies listed below. Concurrent chronic kidney disease does not...

I agree completely with Dr. @Dr. First Last's scholarly answer. One additional thought: The underlying pathophysiology is likely the loss of ability to convert glutamine to glutamate in the renal proximal tubule. This is commonly seen in type 2 diabetics with advanced chronic kidney disease but can ...