Pk. Grover et Rl. Ryall, URATE AND CALCIUM-OXALATE STONES - FROM REPUTE TO RHETORIC TO REALITY, Mineral and electrolyte metabolism, 20(6), 1994, pp. 361-370
A critical appraisal of the evidence commonly cited to support a link
between high urate excretion and calcium oxalate (CaOx) urinary calcul
i is presented. Two theories have been invoked to provide a scientific
explanation for urate's apparent promotory effect. The first proposes
that urinary urate crystals promote CaOx precipitation by the phenome
non of epitaxy; the second hypothesis is that colloidal particles of u
rate reduce the inhibitory activity of urinary glycosaminoglycans (GAG
s) which normally prevent the crystallization of CaOx. However, to the
present, neither has been verified experimentally. More recent resear
ch from our group has revealed that at normal physiological pH values
dissolved urate directly promotes CaOx precipitation by the classsic '
salting-out' effect by enhancing nucleation, growth and aggregation of
CaOx crystals. It is therefore suggested that the beneficial effect o
f allopurinol in reducing CaOx stone recurrences may be attributed to
its lowering the urinary output of urate and thereby reducing the prob
ability that CaOx will be salted out of urine, rather than to epitaxy
or inactivation of urinary GAGs.