For recurrent uric acid stones, which preventive strategy is recommended?

• A. Alkalinize urine with potassium citrate and IVF
• B. Low-sodium diet alone
• C. Start allopurinol only without alkalinization
• D. Increased protein intake

Answer: (A)

Preventing recurrent uric acid stones hinges on keeping the urine alkaline and well hydrated. Uric acid stones form more readily in acidic urine, so raising urine pH increases uric acid solubility and reduces crystal formation. Potassium citrate alkalinizes the urine and provides citrate, which not only raises pH but also helps prevent crystal aggregation. Coupled with high fluid intake to dilute the urine, this approach lowers the concentration of uric acid and discourages stone formation. Other strategies—like using allopurinol alone, which lowers uric acid production but doesn’t address pH, or increasing protein and lowering salt—don’t target the main risk factor as effectively for recurrent uric acid stones.