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Acute uric acid nephropathy.

J D Conger1

  • 1University of Colorado Health Science Center, Denver.

The Medical Clinics of North America
|July 1, 1990
PubMed
Summary
This summary is machine-generated.

Acute uric acid nephropathy occurs when high purine metabolism causes kidney damage. Diagnosis involves clinical signs, hyperuricemia, and a high urinary uric acid-to-creatinine ratio. Treatment includes allopurinol and dialysis if needed.

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Area of Science:

  • Nephrology
  • Oncology
  • Metabolic Disorders

Background:

  • Uric acid, the end-product of purine metabolism, is poorly soluble in acidic urine.
  • Rapid cell turnover in malignancies like leukemia and lymphoma increases uric acid production.
  • Chemotherapy and radiation accelerate cell lysis, further elevating uric acid levels.

Purpose of the Study:

  • To describe the pathophysiology, diagnosis, and management of acute uric acid nephropathy.
  • To highlight the role of hyperuricemia and hyperuricosuria in diagnosis.
  • To discuss preventive and therapeutic strategies for this condition.

Main Methods:

  • Clinical case review and analysis of diagnostic markers.
  • Evaluation of preventive treatments like xanthine oxidase inhibition (allopurinol) and alkaline diuresis.

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  • Assessment of dialysis therapy, particularly hemodialysis, for managing acute renal failure.

    • Main Results:

    • Acute uric acid nephropathy is characterized by oliguria, hyperuricemia, and hyperuricosuria.
    • A urinary uric acid-to-creatinine ratio > 1 aids in differentiating this condition.
    • Allopurinol and alkaline diuresis are key preventive measures, though renal failure can still occur.
    • Hemodialysis is effective for azotemia and reducing urate burden.

    Conclusions:

    • Acute uric acid nephropathy is a preventable complication of conditions with high cell turnover.
    • Early diagnosis based on clinical context and laboratory findings is crucial.
    • Management involves prevention with allopurinol and alkaline diuresis, with dialysis as a supportive measure.