What is your approach to elevated urine uric acid levels in a recurrent calcium based stone former?

There was good evidence from controlled trials supporting the use of allopurinol in hyperuricosuric calcium stone formers. That said, the trials are now pretty old and I would tend to treat other risks first (unless there was another reason to lower the uric acid like gout). In general, a lower animal protein diet makes sense for both calcium oxalate and uric acid stone formers, and I would advise that based upon the patients actual risk factors. If the patient has uric acid stones, treating to ...

Dr. @Dr. First Last speaks for me also. The trial that showed the benefit of using allopurinol in calcium oxalate stone disease used the usual endpoint: A decrease in stone passages. The idea that allopurinol is a "super glue" for kidney stones makes no physiologic sense. In fact, how it would Physiologically decrease calcium oxalate stone formation is a good question without a good answer, in my opinion. I agree that treating other metabolic abnormalities first is highly appropriate.

As Dr. Lie...