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Nephropathy, Urate

Jeremy R. Kenison, DO Reviewed 06/2019
 


BASICS

  • Uric acid requires the enzyme uricase to convert it to a more soluble compound (allantoin); in humans, the enzyme is absent, making the kidney more susceptible to the side effects of uric acid ...

DIAGNOSIS

  • Hyperuricemic acute renal failure

    • Hyperkalemia: weakness, paresthesias, muscle cramps, nausea, vomiting, diarrhea, anorexia

    • Hyperphosphatemia: acute nephrocalcinosis

    • Hypocalcemia: muscle cram...

TREATMENT

MEDICATION

  • Hyperuricemic acute renal failure: Prevent by pretreating with allopurinol or rasburicase and hydrating patient prior to administration of chemotherapeutic agents for leukemia or l...

ONGOING CARE

DIET

  • Moderation of purine intake

  • For nephrolithiasis, fluid intake to produce urine output of >2 L/day unless limited by acute or chronic renal failure

  • In renal failure, restrict sodium f...

REFERENCES

1
Mende C. Management of chronic kidney disease: the relationship between serum uric acid and development of nephropathy. Adv Ther.  2015;32(12):1177–1191. [View Abstract on OvidMedline...

ADDITIONAL READING

  • Gibson T. Hyperuricemia, gout and the kidney. Curr Opin Rheumatol.  2012;24(2):127–131. [View Abstract on OvidMedline]

  • Johnson RJ, Nakagawa T, Jalal D, et al. Uric acid and chro...

CODES

ICD10

  • N28.89 Other specified disorders of kidney and ureter

  • N20.0 Calculus of kidney

  • M10.30 Gout due to renal impairment, unspecified site

ICD9

  • 274.10 Gouty nephropathy, unspecified

  • 274.11 Uric acid n...

CLINICAL PEARLS

  • Uric acid is water-insoluble in the acidic environment of the distal nephron of the kidney.

  • Due to the lack of the enzyme uricase, which converts uric acid into a more soluble compound,...

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