Pharmacological Chemolysis of Uric Acid Lithiasis in A Patient with Crohn's Disease.

Abstract

Patients with chronic diarrhoea or ileostomies suffer from electrolyte and urinary disorders and are prone to developing uric acid or calcium oxalate stones. Evidence is lacking regarding the management of uric acid stones in patients with inflammatory bowel diseases. We present the case of a male patient with Crohn's disease and carrying an ileostomy. He was diagnosed with uric acid urolithiasis (stone size of 11 mm located in the left pyeloureteral junction) after presenting to the emergency room during an episode of left renal colic. Results of the 24-hour urinalysis showed an acidic pH (pH <5), consistent with hyperuricosuria. The suspicion of uric acid lithiasis was confirmed after performing an X-ray diffraction analysis of a lithiasic fragment that passed during acute renal colic. The patient was prescribed with urinary alkalinisers (medical treatment) and dietary recommendations. After 12 months of treatment and urine pH monitoring, the patient achieved complete chemolysis while maintaining the stability of his underlying Crohn's disease. The patient had no complications during follow-up, referring adequate gastrointestinal tolerance to treatment and denying side effects. The patient remains asymptomatic and is being followed-up on an outpatient basis. He continues on prophylactic treatment (Lit-Control® pH Up) to maintain the pH in the non-acidic range.