From the Guidelines
Uric acid stones are the type of urinary stones most commonly associated with lymphoma. Patients with lymphoma, particularly during treatment, often experience tumor lysis syndrome, which leads to the rapid breakdown of cancer cells, releasing large amounts of uric acid into the bloodstream, overwhelming the kidneys' ability to filter it properly, as noted in 1. As a result, uric acid can crystallize in the urinary tract, forming stones. The risk is especially high in patients with high-grade lymphomas or large tumor burdens who undergo chemotherapy.
Some key points to consider in the management and prevention of uric acid stones in lymphoma patients include:
- Maintaining good hydration to help flush out uric acid and other substances that can contribute to stone formation.
- Urinary alkalinization with medications like sodium bicarbonate to increase the pH of the urine, making it less likely for uric acid to crystallize.
- Prophylactic use of allopurinol or rasburicase to reduce uric acid levels, as these medications can help prevent the formation of uric acid stones by lowering uric acid production or increasing its excretion, as discussed in 1 and 1.
These interventions are crucial during the initial phases of lymphoma treatment when cell turnover is highest and the risk of stone formation peaks. It's also important to note that the management of uric acid stones may involve medical treatment to manipulate the urinary pH, as suggested in 1, and potentially the use of medications like thiazides, citrates, or allopurinol, depending on the patient's specific condition and stone composition, as mentioned in 1.
Overall, the association between lymphoma, particularly during its treatment, and the development of uric acid stones is well-established, and preventive measures should be taken to minimize this risk and its potential complications on morbidity, mortality, and quality of life.
From the Research
Urinary Stones Associated with Lymphoma
- Uric acid stones are associated with lymphoma, as patients with hematological malignancies, including lymphoma, are at risk of developing hyperuricemia and subsequent uric acid stone formation 2.
- The formation of uric acid stones is related to hyperuricosuria, low urinary volume, and persistently low urinary pH, which can be exacerbated by conditions such as lymphoma 3.
- Uric acid stones account for 10%-15% of all urinary stones and can be treated with pharmacotherapy, extracorporeal shock wave lithotripsy, or other minimally invasive procedures 3.
- Potassium citrate therapy can help prevent new stone formation and reduce the risk of uric acid stone recurrence by increasing urinary citrate and pH, and decreasing urinary saturation of calcium oxalate 4, 5.
Risk Factors and Prevention
- Hyperuricosuria, low urinary volume, and persistently low urinary pH are risk factors for uric acid stone formation, which can be associated with lymphoma 2, 3.
- Dietary adjustments, mineral water supplementation, and alkali supplementation with potassium citrate or potassium bicarbonate can help increase urinary pH and prevent stone recurrence 5.
- Rasburicase, a recombinant urate oxidase, can be used to prevent and treat hyperuricemia in patients with hematological malignancies, including lymphoma, and reduce the risk of uric acid stone formation 2.