Editing Kidney stone disease (section)

=== Urine alkalinization ===
The mainstay for medical management of uric acid stones is [[Alkalinity|alkalinization]] (increasing the [[pH]]) of the urine. Uric acid stones are among the few types amenable to dissolution therapy, referred to as [[Lysis|chemolysis]]. Chemolysis is usually achieved through the use of oral medications, although in some cases, intravenous agents or even instillation of certain irrigating agents directly onto the stone can be performed, using antegrade [[nephrostomy]] or [[retrograde ureteral]] catheters.<ref name=Knudsen2007 /> [[Acetazolamide]] is a medication that alkalinizes the urine. In addition to acetazolamide or as an alternative, certain dietary supplements are available that produce a similar alkalinization of the urine. These include [[alkali citrate]], [[sodium bicarbonate]], [[potassium citrate]], [[magnesium citrate]], and [[bicitrate]] (a combination of citric acid monohydrate and sodium citrate dihydrate).<ref>{{cite journal | vauthors = Cicerello E, Merlo F, Maccatrozzo L | title = Urinary alkalization for the treatment of uric acid nephrolithiasis | journal = Archivio Italiano di Urologia, Andrologia | volume = 82 | issue = 3 | pages = 145–8 | date = September 2010 | pmid = 21121431 }}</ref> Aside from alkalinization of the urine, these supplements have the added advantage of increasing the urinary citrate level, which helps to reduce the aggregation of calcium oxalate stones.<ref name=Knudsen2007 />

Increasing the urine pH to around 6.5 provides optimal conditions for [[Dissolution (chemistry)|dissolution]] of uric acid stones. Increasing the urine pH to a value higher than 7.0 may increase the risk of calcium phosphate stone formation, though this concept is controversial since citrate does inhibit calcium phosphate crystallization. Testing the urine periodically with [[nitrazine]] paper can help to ensure the urine pH remains in this optimal range. Using this approach, stone dissolution rate can be expected to be around {{convert|10|mm|in|1|abbr=on}} of stone radius per month.<ref name=Knudsen2007 />

==== Slaked lime ====
[[Calcium hydroxide]] decreases urinary calcium when combined with food rich in oxalic acid such as green leafy vegetables.<ref>{{cite web |url=https://www.researchgate.net/publication/287536542 |title=Effect of addition of calcium hydroxide to foods rich in oxalic acid on calcium and oxalic acid metabolism {{!}} Request PDF<!-- Bot generated title --> |access-date=6 March 2021 |archive-date=7 November 2021 |archive-url=https://web.archive.org/web/20211107061411/https://www.researchgate.net/publication/287536542_Effect_of_addition_of_calcium_hydroxide_to_foods_rich_in_oxalic_acid_on_calcium_and_oxalic_acid_metabolism |url-status=live }}</ref>