Gout and Kidney Stones: Understanding the Connection and Prevention

If you have gout, you're at significantly higher risk for developing kidney stones. Understanding this connection—and taking steps to prevent kidney stones—is an essential part of comprehensive gout management.

The Gout-Kidney Stone Connection

Why Are They Related?

Both conditions are linked to high uric acid levels:

Gout:

Uric acid crystals form in joints
Causes painful inflammation

Uric Acid Kidney Stones:

Uric acid crystals form in kidneys or urinary tract
Can cause severe pain and complications

About 20% of people with gout will develop kidney stones at some point, compared to only 1% of the general population.

Types of Kidney Stones in Gout Patients

Uric Acid Stones (Most Common in Gout)

Made entirely of uric acid
Account for 5-10% of all kidney stones
More common in people with gout
Can often be dissolved with treatment

Risk Factors:

High uric acid levels
Acidic urine (low pH)
Dehydration
High-purine diet

Calcium Oxalate Stones

Most common type overall
Can also occur in people with gout
Harder to dissolve than uric acid stones
May require different treatment

Risk Factors:

Low urine volume
High dietary oxalate
Low calcium intake (counterintuitively)
Certain medications

Signs and Symptoms of Kidney Stones

Common Symptoms

Severe pain in back, side, or lower abdomen
Pain that comes in waves and fluctuates in intensity
Pain during urination
Pink, red, or brown urine (blood in urine)
Cloudy or foul-smelling urine
Nausea and vomiting
Persistent need to urinate
Urinating small amounts frequently
Fever and chills (if infection present)

When to Seek Immediate Care

Get emergency help if you experience:

Severe pain you can't sit still through
Pain with nausea and vomiting
Pain with fever and chills
Blood in urine
Difficulty urinating

How High Uric Acid Causes Kidney Stones

The Process

High uric acid in blood → filters through kidneys
Concentrated in urine → especially when dehydrated
Acidic urine environment → makes uric acid less soluble
Crystals form → in kidneys or urinary tract
Crystals grow → into larger stones

Risk Factors Specific to Gout Patients

Elevated uric acid levels - Higher concentrations in urine
Acidic urine pH - People with gout often have more acidic urine (pH < 5.5)
Low urine volume - Dehydration concentrates uric acid
Medications - Some gout medications can initially increase risk
Dietary factors - High-purine diet affects both conditions

Prevention Strategies

1. Hydration (Most Important)

Water dilutes uric acid in urine and increases urine volume:

Goal:

Drink 2-3 liters (8-12 glasses) daily
More in hot weather or during exercise
Aim for pale yellow urine

Tips:

Drink water throughout the day
Keep water bottle accessible
Set reminders if needed
Increase slowly if not used to high intake

2. Alkalize Your Urine

Less acidic urine helps prevent uric acid stone formation:

Foods That Alkalize:

Citrus fruits (lemons, limes, oranges)
Most vegetables
Low-fat dairy
Nuts

Avoid Excessive:

Animal protein
Salt
Sugary drinks

Medical Options:

Potassium citrate supplements (prescribed)
Sodium bicarbonate (under doctor guidance)

Target: Urine pH of 6.0-6.5 (measured with home pH strips or by doctor)

3. Control Uric Acid Levels

Keeping uric acid below 6.0 mg/dL reduces both gout attacks and kidney stone risk:

Medications:

Allopurinol
Febuxostat
Probenecid (not for uric acid stones)

Lifestyle:

Low-purine diet
Maintain healthy weight
Limit alcohol
Avoid sugary drinks

4. Dietary Modifications

Increase:

Water and fluids
Fruits and vegetables
Whole grains
Low-fat dairy
Citrus fruits and juices

Limit:

Red meat and organ meats
High-purine seafood
Alcohol (especially beer)
Sugary beverages
Excessive salt
High-dose vitamin C (above 1,000 mg - can increase oxalate)

Protein Intake:

Moderate animal protein (not excessive)
Consider plant-based proteins
Aim for 0.8-1.0 g per kg body weight

5. Manage Weight

Obesity increases risk for both conditions:

Lose weight gradually (1-2 lbs/week)
Avoid crash diets
Combine diet with exercise
Maintain long-term

6. Limit Salt

High sodium intake can:

Increase calcium in urine
Reduce citrate in urine
Worsen high blood pressure

Goal: Less than 2,300 mg sodium daily (about 1 teaspoon of salt)

7. Don't Overdo Vitamin C

While vitamin C can help lower uric acid:

High doses (> 1,000 mg) may increase oxalate
Can raise kidney stone risk
Stick to 500-1,000 mg daily or less

Treatment Options for Kidney Stones

Small Stones (< 5mm)

Often pass naturally:

Drink lots of water
Pain medication
Alpha-blockers to relax ureter
Strain urine to catch stone

Timeline: May take days to weeks

Larger Stones or Complications

May require procedures:

Lithotripsy:

Sound waves break up stones
Non-invasive
Outpatient procedure

Ureteroscopy:

Scope inserted to remove stone
More invasive
Very effective

Percutaneous Nephrolithotomy:

Surgical removal
For very large stones
Requires hospitalization

Dissolving Uric Acid Stones

Unlike other types, uric acid stones can sometimes be dissolved:

Alkalinization therapy (potassium citrate)
High fluid intake
Uric acid-lowering medication
May take weeks to months

Special Considerations with Gout Medications

Allopurinol and Febuxostat

Generally helpful for preventing stones
Lower uric acid production
Reduce concentration in urine

Probenecid

Increases uric acid in urine
Can increase kidney stone risk
Generally avoided in people with history of stones

Starting Uric Acid-Lowering Drugs

When first starting treatment:

Uric acid levels may fluctuate
Increased stone risk temporarily
Ensure adequate hydration
May need prophylaxis medication

Monitoring and Testing

Regular Checks

If you have gout:

Monitor uric acid levels (blood test)
Check kidney function periodically
Consider urine pH testing
24-hour urine collection (if high risk)

24-Hour Urine Test

Measures:

Urine volume
Uric acid excretion
Calcium levels
Oxalate levels
Citrate levels
Urine pH

Helps determine:

Stone type risk
Treatment approach
Whether you overproduce or under-excrete

Living with Both Conditions

Coordinated Care

See both rheumatologist and urologist if needed
Ensure medications don't conflict
Regular monitoring of both conditions
Comprehensive prevention plan

Lifestyle Adjustments

Prioritize hydration
Maintain consistent low-purine diet
Manage weight
Regular exercise
Stress management
Adequate sleep

Tracking and Monitoring

Keep records of:

Uric acid levels
Kidney stone episodes
Dietary intake
Fluid consumption
Symptoms of both conditions

Download Gout Guru to track your uric acid levels, hydration, diet, and symptoms—helping you manage both gout and prevent kidney stones.

Questions to Ask Your Doctor

"What's my risk for kidney stones?"
"Should I test my urine pH?"
"Do I need a 24-hour urine test?"
"Are my medications increasing stone risk?"
"How much should I be drinking daily?"
"Should I see a urologist?"

The Bottom Line

The connection between gout and kidney stones is significant but manageable. The same strategies that help control gout—maintaining healthy uric acid levels, staying well-hydrated, and following a balanced diet—also reduce kidney stone risk.

If you have gout, take kidney stone prevention seriously. With proper hydration, dietary modifications, appropriate medication, and regular monitoring, you can significantly reduce your risk and maintain better overall health.

Start tracking your prevention efforts with Gout Guru to stay on top of both conditions and catch potential problems early.