Recurrence of acute renal failure and renal hypouricaemia

Murakami, T.; Kawakami, Hatsumi; Fukuda, Masakazu; Shiigi, Hideo

doi:10.1007/bf01213352

Cited by 23 publications

(23 citation statements)

References 7 publications

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“…Some patients with hypouricemia had recurrent ARF [7]. Interestingly, Ohta et al [5] indicated that the maximum SCr levels were lower in the recurrent ARF episodes compared with the first episodes, suggesting that recognition of hypouricemia and a doctor's guidance following the first ARF episode may contribute to prevent ARF in the recurrent episode.…”

Section: Discussionmentioning

confidence: 96%

“…Most patients with renal hypouricemia who developed ARF have been Japanese and Asian [1][2][3][4][5][6][7][8][9]. This suggests that subjects who are evaluated for serum uric acid level may be selected from the point of view of cost-effectiveness.…”

Section: Discussionmentioning

confidence: 97%

“…As noted in the paper by Yeun and Hasbargen [9], allopurinol may be useful to prevent recurrence. Murakami et al [7] proposed that oral supplementation of antioxidants or scavengers, such as glutathione, vitamins C and E, and beta-carotene, may help prevent the recurrence of ARF. In Case 2, the patient and her family were educated by a doctor to ensure adequate fluid intake after exercise.…”

Section: Discussionmentioning

confidence: 99%

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Renal hypouricemia in school-aged children: screening of serum uric acid level before physical training

Niimi

Yanagawa

2006

Pediatr Nephrol

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We present two cases of a 12-year-old Japanese boy and a 14-year-old Japanese girl who had exercise-induced acute renal failure (ARF). They experienced general fatigue, nausea/vomiting, and vague discomfort in the abdomen after physical exercise at school. In case of the boy, abdominal pain subsided, but renal dysfunction lasted 17 days, with peak levels of creatinine 9.4 mg/dl and uric acid 11.3 mg/dl. On the other hand, as the girl had suffered from hypouricemia before, she followed a doctor's guidance on prevention of ARF. Consequently, she was promptly diagnosed as having exercise-induced ARF associated with hypouricemia, and rapidly recovered from ARF within a week. The difference between their clinical courses suggested a possibility that previous laboratory evaluation of serum uric acid assisted in the management of exercise-induced ARF associated with hypouricemia. School-aged children, especially Japanese and Asian, may be advised to have their serum uric acid measured before starting physical training at school.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Renal hypouricemia in school-aged children: screening of serum uric acid level before physical training

Niimi

Yanagawa

2006

Pediatr Nephrol

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“…How renal hypouricemia accounts for exercise-induced acute renal failure remains an open question. Two mechanisms have been proposed: either urate nephropathy results from an increase in urate production during exercise (6,18), or renal reperfusion injury due to vasoconstriction results from an exercise-induced increase in oxygen free radicals and a lack of urate, free radical scavengers (24). The first hypothesis raises an interesting question; why has tubular urate precipitation been identified in renal biopsy specimens of only one (6) of these renal hypouricemic patients with exercise-induced acute renal failure (25-28)?…”

Section: Discussionmentioning

confidence: 99%

Clinical and Molecular Analysis of Patients with Renal Hypouricemia in Japan-Influence of URAT1 Gene on Urinary Urate Excretion

Ichida

Hosoyamada²,

Hisatome³

et al. 2004

Journal of the American Society of Nephrology

348

353

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Abstract. Renal hypouricemia is an inherited and heterogeneous disorder characterized by increased urate clearance (CUA). The authors recently established that urate was reabsorbed via URAT1 on the tubular apical membrane and that mutations in SLC22A12 encoding URAT1 cause renal hypouricemia. This study was undertaken to elucidate and correlate clinical and genetic features of renal hypouricemia. The SLC22A12 gene was sequenced in 32 unrelated idiopathic renal hypouricemia patients, and the relationships of serum urate levels, and CUA/creatinine clearance (Ccr) to SLC22A12 genotype were examined. Uricosuric (probenecid and benzbromarone) and anti-uricosuric drug (pyrazinamide) loading tests were also performed in some patients. Three patients had exercise-induced acute renal failure (9.4%), and four patients had urolithiasis (12.5%). The authors identified eight new mutations and two previously reported mutations that result in loss of function. Thirty patients had SLC22A12 mutations; 24 homozygotes and compound heterozygotes, and 6 heterozygotes. Mutation G774A dominated SLC22A12 mutations (74.1% in 54 alleles). Serum urate levels were significantly lower and CUA/Ccr was significantly higher in heterozygotes compared with healthy subjects; these changes were even more significant in homozygotes and compound heterozygotes. These CUA/Ccr relations demonstrated a gene dosage effect that corresponds with the difference in serum urate levels. In contrast to healthy subjects, the CUA/Ccr of patients with homozygous and compound heterozygous SLC22A12 mutations was unaffected by pyrazinamide, benzbromarone, and probenecid. The findings indicate that SLC22A12 was responsible for most renal hypouricemia and that URAT1 is the primary reabsorptive urate transporter, targeted by pyrazinamide, benzbromarone, and probenecid in vivo.Approximately 90% of all urate that is filtered through the glomerulus is eventually reabsorbed. A four-component hypothesis has been proposed to explain the renal urate transport mechanisms; it includes glomerular filtration, presecretory reabsorption, secretion, and postsecretory reabsorption (1,2). Renal hypouricemia is a common inherited and heterogeneous disorder characterized by impaired tubular urate transport (3). The incidence of renal hypouricemia has been reported to be 0.12 to 0.72% (4,5), and exercise-induced acute renal failure and nephrolithiasis have been reported as complications (6).Renal hypouricemia has been classified into the following five types according to responses to the anti-uricosuric drug pyrazinamide, and the uricosuric drug, probenecid: (a) a presecretory reabsorptive defect with an attenuated response to both pyrazinamide and probenecid (3); (b) a post-secretory reabsorptive defect when pyrazinamide suppressible urate clearance (CUA) is not influenced by probenecid (7); (c) total inhibition of urate reabsorption when pyrazinamide induces elimination of CUA exceeding the rate of glomerular filtration (8); (d) enhanced secretion when the pyrazinamide suppressible CUA ...

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“…Approximately 10% of patients with renal hypouricemia have a past history of ALPE, and, accordingly, hypouricemia is regarded as a risk factor for AKI. UA acts as an antioxidant, and it is thought that it may scavenge a large quantity of free radicals generated by exercise [7]. As the patients with renal hypouricemia had small amounts of UA, the kidney may have suffered severe effects from active oxygen.…”

Section: Discussionmentioning

confidence: 99%

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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Recurrence of acute renal failure and renal hypouricaemia

Cited by 23 publications

References 7 publications

Renal hypouricemia in school-aged children: screening of serum uric acid level before physical training

Renal hypouricemia in school-aged children: screening of serum uric acid level before physical training

Clinical and Molecular Analysis of Patients with Renal Hypouricemia in Japan-Influence of URAT1 Gene on Urinary Urate Excretion

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

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