Uric Acid Kidney Stones treatment/prevention

[HighMinus]

My 60 year old husband passed small uric acid type kidney stones in August (per lab analysis of stones), had a blood test that showed high uric acid and was put on Allopurinol 100mg (twice daily) about two weeks ago. He recently lost weight after having an angioplasty with stent in late July (blood work shows normal range for cholesterol- blood glucose elevated at 117, blood pressure is normal, pulse 50 to 60). His cardiologists were surprised about the need for angioplasty He is also on meds for Atrial fibulation.
He has been eating a healthier diet, sticking to low fat/fat free foods, more fresh fruits and vegatables, whole grains, drinks mainly water (8 to 10 glasses a day) and herbal tea etc. His is a non drinker and non smoker. In fact, he has avoided alcohol in recent years while on meds for a-fib.
What could be causing his recent kidney stone attack - still had signs of more crystals this wek? Rapid weight loss?  Meds? What about purines in meats & veggies - everything has purines even turkey, chicken - also read to avoid some fish like tuna and shell fish?? Do you stay on Allpurinol long tern - concern about effects on kidneys??
He is very frustated about getting correct calorie in tack while avoiding many foods - has to travel again soon on business and can't keep having stone.
Please help - his Drs are not helping with detailed diet - turning to online research.
Thanks very much,
Concerned wife

[HighMinus]

Thanks for your reply to my questions.
My husband has a check with his primary care Dr (Internal Medicine) this week. He will ask to have a follow up blood test to check his current uric acid level. He also needs a referral to a registered dietician who can come up with a recommended diet with actual sample menus that take into account the need to eat low fat, low cholesterol, low sugar and low purine foods. It is too confusing to come up with the right calorie count and mix of foods based on the research we have been doing on our own. He is continuing with too rapid a weight loss.He drinks enough water and is frustrated with his health issues from recent months.
Based on reading online about purines in food and uric acid, there are a number of foods my husband likes to eat that have high purines and will then contribute to high uric acid. He is now trying to avoid certain fish and shellfish like crab and shrimp. I also read that vegetables like asparagus, mushrooms and spinach are high in purines.
Hope between his Dr and a dietician he can come up with some solutions, so the kidney stone attacks do not return. Again, Thanks for your comments.

[David Rudnick, M.D.]

I have many stone patients who protest that their diet is "healthy" and they still get stones, but the reality is that even lean "healthy" proteins like fish and chicken are pure protein and are broken down to uric acid by the body.  Uric acid stone form for three reasons, and three reasons alone:

1.  Low urine volume
2.  Low urine pH (too much acidity in the urine)
3.  High urine uric acid.

Changing any of these three variables will decrease the likelihood of uric acid stones, so dietary advice centers on increasing fluid intake (to produce 2L of urine daily), lowering protein in the diet (I tell my patients to still enjoy protein, but eat smaller portion sizes), and reducing the acidity of the urine by adding lots of fruits to the diet, or considering a medication like potassium citrate.

If his diet has changed substantially after his angioplasty, it would be reasonable to ask his doctor about trying to stop the allopurinol at some point and recheck the uric acid levels.