Nephrolithiasis is a common condition in the general population. About 5-10% of all kidney stones is composed of uric acid, however the prevalence of uric acid stones significantly increases among patients with obesity, diabetes or metabolic syndrome. A key role in the pathogenesis of uric acid nephrolithiasis is played by excessive urinary acidification, which increases the risk of precipitation of uric acid salts in the urine. An excessive presence of uric acid in the urine, due to increased circulating levels or tubular defects, might contribute to the pathogenesis. The cornerstones of prevention of recurrences of uric acid stones include interventions aimed at expanding urine volume and alkalinizing the urine.