Acute Uric Acid Nephropathy

Acute Uric Acid Nephropathy causes due to the accumulation or deposition of urate or uric acid in the body. It can be seen as a part of the tumor lysis syndrome and is generally observed in the patients with instigation of chemotherapy, those with acute neoplastic disorders or those undergoing radiation therapies for treating the malignancies with rapid cell turnover such as leukemia or lymphoma.  It can also be seen in the initial stages of the treatment, because of the spontaneous tumor cell lysis. More possibilities are seen in lymphoma.

Acute uric acid nephropathy is also termed as AUAN.  AUAN rapidly worsens or reduces the rate of kidney functioning. This occurs due to the increase in the uric acid levels in the urine. In medical terms, it is called as hyperuricosuria.  AUAN is allied with a chronic or an acute form such as nephrolithiasis and gouty nephropathy. All of them are caused due to the creation of uric acid calculi at certain level. An acute attack of gout may also result in to AUAN.

How Uric Acid Can Cause AUAN?

Uric acid is an end product which is formed during the process of purine nucleotide metabolism. It is relatively insoluble in water or has limited solubility, which may create complications in a human being, particularly in the acidic base of the distal nephron of the kidney. It causes complications, since human body does not have any enzyme uricase, which may convert the uric acid into more dissolving compound.

Production of excess uric acid may cause three types of kidney disorders:

  • Acute Uric Acid Nephropathy
  • Uric Acid Nephrolithiasis
  • Chronic Urate Nephropathy

Indications That State, You Are Suffering From Acute Uric Acid Nephropathy:

There are certain indications or signs, which may depict that you are undergoing AUAN.

  • Abdominal Pain:

Patient suffering from AUAN may experience abdominal pain, which can be chronic or long term. Initially, this pain may be abrupt or sharp. They may also experience tenderness in the lower abdomen that may cause due to the consequences influencing the variety of organs. This abdominal pain may be minor or sometimes, it can reflect a serious problem related to one of the abdominal organs. Chronic and constant abdominal pain should be demonstrated to the physician and get treated appropriately.

  • Cloudy Urine :

Cloudy and foamy urine can be a symptom of AUAN. It may sometimes occur along with dehydration. There are certain consequences that may create surplus crystalline substances or protein in the urine, resulting in to foamy or cloudy urine consistently. These crystalline substances may be the uric acid crystals. Moreover, many other causes that may drain blood elements in the urine can make the urine cloudy or murky in appearance. In order to acknowledge the exact reason or detect whether it is due to AUAN, consulting a doctor is preferable.

  • Swelling on Leg (Edema ):

In medical terms, Edema is used for swelling of legs. It occurs due to the excessive fluid like uric acid in the tissues. Other roots for edema involve disorders that results into thick skin layers. Such diseases involve eosinophilic fasciitis and scleroderma. In such disorders, the swelling of the leg is called as non-pitting edema.

There are some more symptoms that indicate towards the probability of AUAN:

  • Reduction in the percentage of urine
  • Pain with tenderloin
  • Inflammation in kidney

The most often noticeable symptoms are vomiting, seizures, nausea and lethargy.

What is the Base for the Diagnosing of Acute Uric Acid Nephropathy?

The main cause of acute kidney failure is reduction in the production of urine and the rapid increasing levels of serum creatinine in the urine. There are some more kidney failure disorders that are caused due to the excessive production of uric acid, but acute uric acid nephropathy can be differentiated by the presence of creatinine to uric acid ratio greater than one in any of the urine samples that are kept randomly.

Pathophysiology of AUAN:

Deposition of uric acid crystals in the kidney tubules and interstitium causes acute uric acid nephropathy. These crystals are responsible to create partial or complete obstruction of the renal pelvis, ureter or assembling ducts. This type obstruction is usually bilateral, and patients have to undergo a clinical treatment of acute renal failure.

Preventive Measures For AUAN :

With an aim to prevent the cause of acute uric acid nephropathy, patients going for the treatment of cytotoxic drugs, are provided with Allopurinol or rasburicase primarily.

How to Treat Acute Uric Acid Nephropathy?

The treatment focuses on the prevention of deposition of excess uric acid in the urinary system. This is done by increasing the volume of urine with some effective diuretics like furosemide. Raising the PH level of urine more than 7 (alkaline),  is mostly quite difficult to achieve, moreover, acetazolamide or sodium bicarbonate are usually tried to increase the solubility of uric acid.

In case, if the other measure did not work, dialysis or hemodialysis is preferred during the treatment.

Acute Uric Acid Nephropathy can be reduced and controlled by taking certain necessary measures. These treatments should be taken under the administration of the doctor.

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