WordNet

of critical importance and consequence; "an acute (or critical) lack of research funds"
having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
of an angle; less than 90 degrees
a salt of uric acid

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(先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/04/28 13:01:28」(JST)

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Acute uric acid nephropathy (AUAN, also acute urate nephropathy) is a rapidly worsening (decreasing) kidney function (renal insufficiency) that is caused by high levels of uric acid in the urine (hyperuricosuria).

Causes

Acute uric acid nephropathy is usually seen as part of the acute tumour 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 (high incidence in Burkitt's lymphoma).

Acute uric acid nephropathy can also be caused by an acute attack of gout.

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.

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 can be given allopurinol or rasburicase (a recombinant urate oxidase) prior to treatment with cytotoxic drugs.

Treatment

Treatment is focused on preventing deposition of uric acid within the urinary system by increasing urine volume with potent diuretics such as furosemide. Raising the urinary pH to a level higher than 7 (alkalinization) is often difficult to attain, although sodium bicarbonate and/or acetazolamide are sometimes used in an attempt 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. doi:10.1001/archinte.137.7.839. 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 ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-140235-4

UpToDate Contents

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1. 尿酸による腎疾患 uric acid renal diseases
2. 腫瘍崩壊症候群：定義、発病メカニズム、臨床症状、原因および危険因子 tumor lysis syndrome definition pathogenesis clinical manifestations etiology and risk factors
3. 無症候性高尿酸血症 asymptomatic hyperuricemia
4. 尿酸のバランス uric acid balance
5. 腫瘍崩壊症候群：予防および治療 tumor lysis syndrome prevention and treatment

English Journal

The fructose tolerance test in patients with chronic kidney disease and metabolic syndrome in comparison to healthy controls.

Donderski R1, Miśkowiec-Wiśniewska I2, Kretowicz M3, Grajewska M4, Manitius J5, Kamińska A6, Junik R7, Siódmiak J8, Stefańska A9, Odrowąż-Sypniewska G10, Pluta A11, Lanaspa M12, Johnson RJ13.
BMC nephrology.BMC Nephrol.2015 May 3;16(1):68. [Epub ahead of print]
BACKGROUND: Fructose acutely raises serum uric acid in normal subjects, but the effect in subjects with metabolic syndrome or subjects with chronic kidney disease is unknown. The aim of the study was to evaluate changes in serum uric acid during the fructose tolerance test in patients with chronic k
PMID 25935771

Hyperuricemia-induced NLRP3 activation of macrophages contributes to the progression of diabetic nephropathy.

Kim SM1, Lee SH1, Kim YG1, Kim SY1, Seo JW1, Choi YW1, Kim DJ1, Jeong KH1, Lee TW1, Ihm CG1, Won KY2, Moon JY3.
American journal of physiology. Renal physiology.Am J Physiol Renal Physiol.2015 May 1;308(9):F993-F1003. doi: 10.1152/ajprenal.00637.2014. Epub 2015 Jan 28.
IL-1β-secreting nucleotide-binding oligomerization domain protein 3 (NLRP3) inflammasomes play a pivotal role in triggering innate immune responses in metabolic disease. We investigated the role of soluble uric acid in NLRP3 inflammasome activation in macrophages to demonstrate the effect of system
PMID 25651569

Plasma neutrophil gelatinase-associated lipocalin as a potential predictor of adverse renal outcomes in immunoglobulin A nephropathy.

Park GY1, Yu CH1, Kim JS1, Kang YJ1, Kwon O1, Choi JY1, Cho JH1, Kim CD1, Kim YL1, Park SH1.
The Korean journal of internal medicine.Korean J Intern Med.2015 May;30(3):345-53. doi: 10.3904/kjim.2015.30.3.345. Epub 2015 Apr 29.
BACKGROUND/AIMS: Neutrophil gelatinase-associated lipocalin (NGAL) is a well-known biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN).METHODS: In total, 91 patients with biopsy-proven IgAN at
PMID 25995665