Allopurinol is an effective prophylactic measure in uric acid lithiasis and massive uric acid crystalluria, both in idiopathic and gouty uric acid lithiasis. In view of the frequency of side effects and the necessity of a lifetime prophylaxis in severe cases of uric acid lithiasis, we consider allopurinol treatment indicated in those patients with idiopathic uric acid lithiasis who do not respond satisfactorily to an alkalinization regime. Allopurinol appears to be indicated in all gouty patients with uric acid lithiasis who do not respond satisfactorily to uricosuric drugs and/or who produce uric acid stones in spite of alkalinization. When treating uric acid lithiasis, the possibility of additional etiology of urolithiasis should be kept in mind, such as a combination with hyperparathyroidism. Finally, in cases of malignant uric acid lithiasis defective tubular uric acid reabsorption should be looked for.
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