Acute uric acid nephropathy: Difference between revisions
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==Overview== | |||
Acute uric acid nephropathy (AUAN) is a rapidly progressive reduction in kidney function ([[renal insufficiency]]) that is caused by high levels of [[uric acid]] in the urine. | |||
==Pathophysiology== | |||
Acute uric acid nephropathy is caused by deposition of uric acid crystals within the kidney interstitium and tubules, leading to partial or complete obstruction of collecting ducts, renal pelvis, or ureter. This obstruction is usually bilateral, and patients follow the clinical course of [[acute renal failure]]. | |||
==Causes== | ==Causes== | ||
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Acute uric acid nephropathy can also be caused by an acute attack of [[gout]]. | Acute uric acid nephropathy can also be caused by an acute attack of [[gout]]. | ||
==Diagnosis== | ==Diagnosis== | ||
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==Treatment== | ==Treatment== | ||
===Medical Therapy=== | |||
Treatment is focused on preventing deposition of uric acid within the urinary system by increasing urine volume with potent diuretics such as [[furosemide]]. The urine must also be alkalinized to pH > 7 using sodium bicarbonate and/or [[acetazolamide]] to increase uric acid solubility. | Treatment is focused on preventing deposition of uric acid within the urinary system by increasing urine volume with potent diuretics such as [[furosemide]]. The urine must also be alkalinized to pH > 7 using sodium bicarbonate and/or [[acetazolamide]] to increase uric acid solubility. | ||
Revision as of 16:16, 29 September 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Acute urate nephropathy
Overview
Acute uric acid nephropathy (AUAN) is a rapidly progressive reduction in kidney function (renal insufficiency) that is caused by high levels of uric acid in the urine.
Pathophysiology
Acute uric acid nephropathy is caused by deposition of uric acid crystals within the kidney interstitium and tubules, leading to partial or complete obstruction of collecting ducts, renal pelvis, or ureter. This obstruction is usually bilateral, and patients follow the clinical course of acute renal failure.
Causes
Acute uric acid nephropathy is usually seen as part of the tumor lysis syndrome in patients undergoing chemotherapy or radiation therapy for the treatment of malignancies with rapid cell turnover, such as leukemia and lymphoma. It may also occur in these patients before treatment is begun, due to spontaneous tumor cell lysis.
Acute uric acid nephropathy can also be caused by an acute attack of gout.
Diagnosis
The picture of acute renal failure is observed: decreased urine production and rapidly rising serum creatinine levels. Acute uric acid nephropathy is differentiated from other forms of acute renal failure by the finding of a urine uric acid/creatinine ratio > 1 in a random urine sample.
Prevention
Patients at risk for acute uric acid nephropathy should be treated with allopurinol prior to treatment with cytotoxic drugs.
Treatment
Medical Therapy
Treatment is focused on preventing deposition of uric acid within the urinary system by increasing urine volume with potent diuretics such as furosemide. The urine must also be alkalinized to pH > 7 using sodium bicarbonate and/or acetazolamide to increase uric acid solubility.
Dialysis (preferably hemodialysis) is started if the above measures fail.
References
- Conger JD (1990). "Acute uric acid nephropathy". Med Clin North Am. 74 (4): 859–71. PMID 2195258
- Robinson RR, Yarger WE (1977). "Acute uric acid nephropathy". Arch Intern Med. 137 (7): 839–40. PMID 879920
- Yu ASL, Brenner BM (2005). "Chapter 266: Tubulointerstitial diseases of the kidney". In Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL. Harrison's Principles of Internal Medicine (16th edition ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-140235-4