Exercise-induced acute renal failure with renal hypouricemia: a case report and a review of the literature

Ohta, Toshiyuki; Sakano, Takashi; Ogawa, Tsuneyoshi; Kato, Junichiro; Awaya, Yutaka; Kihara, Hirotaka; Kinoshita, Yuichi

doi:10.5414/cnp58313

Cited by 41 publications

(33 citation statements)

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“…There are only a small number of reports of kidney biopsy in similar cases. In early reports, the deposition of UA was found in kidney tissue [13], whereas later reports showed renal tubular necrosis, with the assumption that glomeruli had normal histology [14][15][16][17]. In our case, interstitial edema was apparent, although the shape of the renal tubules was maintained and there were no changes observed in the glomeruli.…”

Section: Discussionmentioning

confidence: 43%

A case of renal hypouricemia and a G774A gene mutation causing acute renal injury that was improved by hemodialysis

et al. 2012

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A 16-year-old man came to our hospital complaining of loin pain after a middle-distance race. Following admission, his renal dysfunction worsened rapidly, requiring several hemodialysis sessions. A renal biopsy showed no change in the glomeruli, although interstitial edema was observed. Following the recovery of renal function, we confirmed that his uric acid level was abnormally low and urate clearance was abnormality high. Gene analysis showed that he had a G774A mutation which dominated the SLC22A12 gene encoding the urate transporter 1.

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Section: Discussionmentioning

confidence: 43%

A case of renal hypouricemia and a G774A gene mutation causing acute renal injury that was improved by hemodialysis

et al. 2012

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“…However, a recent study reported that subjects having the common nonsense mutation, W258X, which is responsible for renal hypouricemia, showed significantly reduced renal function independently of age, sex, BMI, hypertension, and serum uric acid levels [8]. In addition, renal hypouricemia is known to be associated with two complications, acute kidney injury (AKI) [9,10] and nephrolithiasis [10,11]. Because both AKI and urolithiasis are risk factors for reduced kidney function [12,13], we hypothesized that individuals with hypouricemia may be at greater risk of reduced kidney function.…”

Section: Introductionmentioning

confidence: 99%

Association between Hypouricemia and Reduced Kidney Function: A Cross-Sectional Population-Based Study in Japan

Wakasugi¹,

Kazama²,

Narita³

et al. 2015

Am J Nephrol

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Background: Hypouricemia, conventionally defined as a serum uric acid level of ≤2 mg/dl, is considered a biochemical disorder with no clinical significance. However, individuals with renal hypouricemia have a high risk of urolithiasis and exercise-induced acute kidney injury, both of which are risk factors for reduced kidney function. Methods: To test the hypothesis that individuals with hypouricemia would be at a higher risk of reduced kidney function, we conducted a population-based cross-sectional study using data from the Specific Health Checkups and Guidance System in Japan. Logistic analysis was used to examine the relationship between hypouricemia and reduced kidney function, defined as estimated glomerular filtration rate <60 ml/min/1.73 m². Results: Among 90,710 men (mean age, 63.8 years) and 136,935 women (63.7 years), 193 (0.2%) and 540 (0.4%) were identified as having hypouricemia, respectively. The prevalence of hypouricemia decreased with age in women (p for trend <0.001), but not in men (p for trend = 0.24). Hypouricemia was associated with reduced kidney function in men (odds ratio, 1.83; 95% confidence interval, 1.23-2.74), but not in women (0.61; 0.43-0.86), relative to the reference category (i.e., serum uric acid levels of 4.1-5.0 mg/dl) after adjusting for age, drinking, smoking, diabetes, hypertension, hypercholesterolemia, obesity, and history of renal failure. Sensitivity analyses stratified by diabetic status yielded similar results. Conclusions: This study is the first to provide evidence that hypouricemia is associated with reduced kidney function in men. Further research will be needed to determine the long-term prognosis of individuals with hypouricemia.

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“…However, we cannot confirm this assumption because we did not conduct mutational studies. Clinically, patients with xanthinuria have not been reported to have EIAKI although renal hypouricemia is often associated with this disorder [21,22]. Our patient did not have any history of acute kidney injury, macrohematuria, or lumbago after exercise, despite playing tennis as a student.…”

Section: Discussionmentioning

confidence: 66%

A case of xanthinuria type I with a novel mutation in xanthine dehydrogenase

et al. 2016

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Hereditary hypouricemia is generally caused by renal hypouricemia, an autosomal recessive disorder that is characterized by impaired renal tubular uric acid transport, or by xanthinuria, a rare autosomal recessive disorder caused by a deficiency of xanthine dehydrogenase (XDH; xanthinuria type I) or by a deficiency of both XDH and aldehyde oxidase (xanthinuria type II). In contrast to renal hypouricemia, which sometimes leads to exercise-induced acute kidney injury (EIAKI), xanthinuria has not been associated with this disorder. We report here a case of xanthinuria type I due to a compound heterozygous mutation. A 46-year-old woman was found to have undetectable plasma and urinary levels of uric acid. She had no symptoms and no history of EIAKI. Xanthinuria type I was diagnosed following the allopurinol loading test. Mutation analysis revealed a compound heterozygous mutation [c.305A[G (p.Gln102Arg) and c.2567delC (p.Thr856Lysfs*73)] in the XDH gene. Of these two mutations, the former is novel. The patient did not exhibit EIAKI. However, because xanthinuria is a rare disease, the identification of additional cases is necessary to determine whether this disease is complicated with EIAKI.

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Exercise-induced acute renal failure with renal hypouricemia: a case report and a review of the literature

Cited by 41 publications

References 0 publications

A case of renal hypouricemia and a G774A gene mutation causing acute renal injury that was improved by hemodialysis

A case of renal hypouricemia and a G774A gene mutation causing acute renal injury that was improved by hemodialysis

Association between Hypouricemia and Reduced Kidney Function: A Cross-Sectional Population-Based Study in Japan

A case of xanthinuria type I with a novel mutation in xanthine dehydrogenase

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