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a salt of uric acid

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/11/04 02:48:52」(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 AS, 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. 痛風の臨床症状および診断 clinical manifestations and diagnosis of gout
3. 無症候性高尿酸血症 asymptomatic hyperuricemia
4. 鉛腎症および鉛関連腎毒性 lead nephropathy and lead related nephrotoxicity
5. 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

English Journal

Enhanced alpha-kinase 1 accelerates multiple early nephropathies in streptozotocin-induced hyperglycemic mice.

Kuo TM1, Hsu HT2, Chung CM1, Yeh KT3, Wu CT4, Lee CP5, Chiang SL6, Huang CM7, Ko YC8.
Biochimica et biophysica acta.Biochim Biophys Acta.2016 Nov;1862(11):2034-2042. doi: 10.1016/j.bbadis.2016.08.010. Epub 2016 Aug 16.
Alpha-kinase 1 (ALPK1) is associated with chronic kidney disease (CKD), type 2 diabetes mellitus and gout. Elevated ALPK1 levels have been observed in the kidneys of patients with diabetes and the white blood cells of patients with gout. As renal injury is a common outcome of CKD, diabetes and gout,
PMID 27542954

From juvenile hyperuricaemia to dysfunctional uromodulin: an ongoing metamorphosis.

Venkat-Raman G1, Gast C2, Marinaki A3, Fairbanks L3.
Pediatric nephrology (Berlin, Germany).Pediatr Nephrol.2016 Nov;31(11):2035-42. doi: 10.1007/s00467-015-3308-y. Epub 2016 Feb 12.
Familial juvenile hyperuricaemic nephropathy (FJHN) is a diagnosis that is easily missed. It has taken a long time to clarify the pathophysiology and prevalence of this disease entity which has been shown to be genetically identical to medullary cystic kidney disease (MCKD) type II. The initial susp
PMID 26872483

Evaluation of the Relationship Between Microalbuminuria and Urine Ischemia-Modified Albumin Levels in Patients with Diabetic Nephropathy.

Bilgi M1, Keser A2, Katlandur H2, Sahin E3, Kalkan AO4, Yildiz M4, Kiyici A3, Keles M5.
Journal of clinical laboratory analysis.J Clin Lab Anal.2016 Oct 1. doi: 10.1002/jcla.22058. [Epub ahead of print]
INTRODUCTION: Ischemia-modified albumin (IMA) is a marker which can be associated with oxidative stress in various ischemic and non-ischemic processes. Oxidative stress plays roles in diabetes mellitus, its complications and pathogenesis. Serum IMA levels are examined in various clinical events. How
PMID 27696561

Japanese Journal

Urate nephropathy associated with impaired kinetic properties of hypoxanthine phosphoribosyl transferase in a 45-day-old infant

Clinical and experimental nephrology 16(1), 164-167, 2012-02-01
NAID 10030343288

運動後急性腎不全(ALPE)

痛風と核酸代謝 = Gout and nucleic acid metabolism 34(2), 145-157, 2010-12-01
NAID 10027722118

腎性低尿酸血症における運動後急性腎不全の発症機序に関する考察

日本小児腎臓病学会雑誌 = Japanese journal of pediatric nephrology 22(2), 147-151, 2009-11-15
NAID 10026411838

Related Pictures

Kidney non-tumor - Urate nephropathy Lower UT PATH at Lake Erie College of Osteopathic Medicine & School of Pharmacy Nephropathy: Urate Nephropathy Chronic Uric Acid Nephropathy - Arkana Laboratories urate nephropathy - Humpath.com - Human pathology 代謝性腎症 - 03. 泌尿器疾患 - MSDマニュアルプロフェッショナル版

★リンクテーブル★

リンク元	「痛風腎」「尿酸腎症」
関連記事	「urate」

「痛風腎」

　　[★]

英: gouty nephropathy, gouty kidney
同: 尿酸塩腎症 urate nephropathy、高尿酸血性腎症 hyperuricemic nephropathy、痛風性腎症、尿酸性腎症 uric acid nephropathy
関: 高尿酸血症

高尿酸血症による腎障害
尿細管障害をきたす。
病理的には間質に尿酸や尿酸一ナトリウム塩の結晶の存在が確認される。これにより間質の閉塞だけでなく炎症反応を惹起する。リンパ球の浸潤、foreign-body giant cell reaction、ついには線維化をきたす。これは腎髄質や腎乳頭で著明である。 (HIM.1809)
GFRはほぼ正常。脳濃縮能の低下、(蛋白尿？) (HIM.1809)