Cholangiocarcinoma and Severe Renal Hypouricemia: A Study of the Renal Mechanisms

Severe Renal Hypouricemia Secondary to Hyperbilirubinemia

“…De caux et al [13,14] also observed that patients with liver cirrhosis showed lower levels of serum UA than normal controls, but none presented hypouricemia or serum bili rubin levels of over 10 mg/dl, and no significant relation between the two parameters could be established. Recent ly, Magoula et al [ 15] reported a case of cholangiocarcinoma with severe and persistent hypouricemia, hyperbiliru binemia and increased renal UA clearance associated with a high pyrazinamide-nonsuppressible urate excre tion and with a postprobenecid urate clearance exceeding glomerular filtration. The authors concluded that renal hypouricemia due to increased renal UA clearance could be the consequence of a selected tubulopathy induced by the presence of a tumor-related humoral factor affecting 355 tubular urate transport, although the attribution of this disorder to hyperbilirubinemia could not be ruled out.…”

Urate Homeostasis in Polycystic Kidney Disease: Comparison With Chronic Glomerulonephritic Kidney

“…[14] The response of urate excretion to drugs that alter renal tubular of urate has been used to analyze the tubular mechanisms of urate transport in man by several authors. [3,4,12,[14][15][16][17][18][19][20][21][22][23] However, secretion and reabsorption may occur in the same tubular segments, and may have active and passive components. Reabsorption of filtered and secreted urate may occur at the same or separate sites and by the same or distinct mechanisms.…”

Hypouricemia and Cancer

“…There are descriptions of hypouricemia associated with liver cell carcinoma [7], multiple myeloma [16][17][18] in which hy pouricemia was secondary to a decrease in both pre-and postsecretory reabsorption of urate. Hypouricemia due to a presecretory defect and a relatively high urate secretion by the renal tubule was reported in association with a cholangiocarcinoma [8]. Finally, a reduction of presecretory rcabsorption was found in a patient with acute myeloid leukemia, though the test was not performed with the probenecid/BB test [19].…”

“…Hypouricemia is a manifestation of some relative rare diseases and thus it may provide a clue to an unsuspected diagnosis [1], Numerous reports have pointed out the association of hypouricemia with malignant neoplasms, including carcinomas of the tongue [1,2], thyroid [3,4], breast [2], lung [5], liver [6,7], gallbladder [2], biliary tract [8], pancreas [1,9], cervix [1] and metastatic cancer of unknown primary site [1], Hodgkin's disease is the malig nant neoplasm most associated with hypouricemia [1,2,[10][11][12][13][14][15], Hypouricemia has also been found in glioblasto ma [1] and sarcoma of unknown origin [1], Fanconi's syn drome is another cause of hypouricemia. This syndrome has been described in patients with myeloma [16][17][18] and acute myeloid leukemia [19].…”