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. Author manuscript; available in PMC: 2021 Nov 1.
Published in final edited form as: Semin Nephrol. 2020 Nov;40(6):564–573. doi: 10.1016/j.semnephrol.2020.12.003

Figure 3: Proposed multi-organ model of uric acid stone formation driven by aciduria.

Figure 3:

Organic (H+; OA− organic anion) acid load due to increased production and uptake by gut lumen exacerbated by decreased hepatic metabolism and increased production. This poses an increased acid load to the kidney, which is capable of excreting the acid. However, impairment of ammonia synthesis and ammonium excretion mandates carriage of H+ by alternative buffers (B); one of which is urate (Ur−) which when protonated, forms the insoluble uric acid.