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Gout, stone composition and urinary stone risk: a matched case comparative study.

PURPOSE: We established the most common stone composition, and serum and urinary biochemical features in patients with gout and urolithiasis.

MATERIALS AND METHODS: We retrospectively searched for the records of patients diagnosed with gout among all those in our stone registry. A matched case cohort of stone formers was generated from our registry who had the same age, gender and body mass index. Primary end points were baseline 24-hour urinary metabolic panels and stone composition. Medications were considered. Groups were compared using the Student t and chi-square/Fisher exact tests with significance considered at p <0.05.

RESULTS: For stone panel evaluation 181 patients met our inclusion criteria. There was no significant difference in 24-hour uric acid between the nongout and gout cohorts but hyperoxaluria was more common in patients with gout (74% vs 61%, p = 0.009). For stone composition analysis 393 patients were included. The gout cohort had lower calcium oxalate monohydrate (39.4% vs 54.7%), calcium oxalate dihydrate (6.0% vs 11.2%) and calcium phosphate (9.6% vs 14.1%) but higher uric acid (42.7% vs 18.2%, each p <0.001). Pure uric acid stones were more common in patients with gout (52.2% vs 22.3%, p <0.001), while calcium oxalate monohydrate (45.2% vs 68.6%, p <0.001), calcium oxalate dihydrate (0.6% vs 3.5%, p = 0.017) and calcium phosphate (1.6% vs 4.9%, p = 0.033) were more common in nongout cases. Patients with gout who were on allopurinol had fewer pure uric acid stones (30.4% vs 56.4%) and more calcium oxalate monohydrate stones (69.6% vs 40.7%, each p <0.001) than those without medication.

CONCLUSIONS: Uric acid stones are the most common pure stone composition in patients with gout but 48% have nonuric acid stones. Allopurinol changes the stone composition distribution in patients with gout to a pattern similar to that in stone formers without gout.

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