Hemodialysis for Acute Anuric Uric Acid Nephropathy

Abstract

\s=b\A patient with acute oliguric uric acid nephropathy was treated with hemodialysis. Recovery in this disorder is based on treatment of both the uremic state and the intrarenal crystal obstruction. Hemodialysis with high uric acid clearance is much more efficient than other forms of therapy in this disorder.(Am J Dis Child 129: [956][957][958] 1975) Acute uñe acia nephropathy \s a 2\ form of acute obstructive renal failure due to intrarenal crystalliza¬ tion of uric acid. A serious iatrogenic complication of leukemia and lymphoma therapy, acute uric acid ne¬ phropathy has become more common as methods for treating these dis¬ eases have become more effective and therefore cause more severe hyperuricemia.1"6 The incidence of this com¬ plication has been estimated to be as high as 10% in patients given inten-

Intrarenal dynamics in the pathogenesis and prevention of acute urate nephropathy.

“…They were anesthetized with pentobarbital (60 mg/kg i.p.) and supplemental doses of pentobarbital (5)(6)(7)(8)(9)(10) mg/kg i.v.) were given as necessary during the study.…”

“…Based on these measurements, it is not surprising that marked hyperuricemia, as occurs in neoplastic diseases and as was mimicked by the present experiments, should lead to deposition of urates and uric acid in the kidney. On the other hand, there is considerable clinical evidence that despite such marked hyperuricemia the degree of renal dysfunction that results is highly variable (5)(6)(7)(8)(9). For this reason the present set of experiments was designed to examine the importance of dynamic factors within the kidney in the pathogenesis and prevention of acuite urate nephropathy.…”

“…It is an established clinical observation that abrupt renal failure can occur as the result of uric acid and urate deposition within the kidney (1)(2)(3)(4)(5)(6)(7)(8). Although hyperuricemia per se is considered to be the necessary and immediate cause of this disorder, the relatively poor correlation between the plasma urate level and degree of renal dysfunction (5)(6)(7)(8)(9) suggests that additional factors must modify the rate of uric acid and urate precipitation and the severity of consequent renal damage.…”

“…Although hyperuricemia per se is considered to be the necessary and immediate cause of this disorder, the relatively poor correlation between the plasma urate level and degree of renal dysfunction (5)(6)(7)(8)(9) suggests that additional factors must modify the rate of uric acid and urate precipitation and the severity of consequent renal damage. In vitro studies have shown the importance of solvent pH and ionic strength in determining the solubility of uric acid and its sodium salt (10)(11)(12).…”

A micropuncture study of the early phase of acute urate nephropathy.

“…Acute urate nephropathy, the clinical designation for marked hyperuricemia and acute renal failure, is a well-known syndrome most frequently encountered in the course of hematologic malignancies (1)(2)(3)(4)(5)(6)(7)(8). Evidence from in vitro biochemical experiments and in vivo morphologic studies (9)(10)(11)(12)(13)(14)(15)(16) suggest that the renal shutdown is due to tubular obstruction from precipitation of excessive filtered and (or) secreted urate.…”