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The proportion of uric acid stones in paediatric stone formers is estimated at 3–4% in the United States [1], although reports from Armenia and Turkey indicate higher proportions of 7 and 15%, respectively [2,3]. Risk factors for uric acid stones include hyperuricosuria, low urinary volume and unduly acidic UpH (<5.5) [4]. Acidic UpH is a recognized risk factor in children consuming a ketogenic diet [5], or those with chronic diarrhoea. In adults, an acidic urine pH is the most common abnormality that predisposes to idiopathic uric acid nephrolithiasis [4]. Urinary alkalinization with potassium citrate is an effective treatment for uric acid kidney stones in adults [6]. We report the case of a 13-year-old boy who presented with recurrent uric acid stones that did not respond to a conventional regimen of potassium citrate therapy.

Circadian variation in urine pH and uric acid nephrolithiasis risk