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Acute Uric Acid Nephropathy: Treatment with Mannitol Diuresis and Peritoneal Dialysis

Acute Uric Acid Nephropathy: Treatment with Mannitol Diuresis and Peritoneal Dialysis Abstract Hyperuricemia in patients with lymphoma and leukemia occurs spontaneously and as a complication of cytotoxic therapy. Increased urinary urate excretion may exceed the ability of the renal tubules to keep urates in solution: Acute renal failure secondary to urate crystallization in the kidneys and genitourinary tract is a sequel.1-3 In the past, if urine flow could not be maintained in the hyperuricemic patient by water loading and alkali therapy, procedures such as ureteral catheterization, nephrostomy, or hemodialysis were required to prevent death from acute renal failure.4 In two patients with severe hyperuricemia, azotemia, and oliguria unresponsive to water loading and alkali therapy, we have been able to avoid hemodialysis. The favorable result in their cases has prompted this report. Diuresis accompanied by lowering of serum uric acid and blood urea nitrogen levels to normal was secured in these patients by the intravenous infusion of the osmotic diuretic, mannitol. References 1. Gold, G. L., and Fritz, R. D.: Hyperuricemia Associated with the Treatment of Acute Leukemia , Ann. Intern. Med. 47:428-434, 1957.Crossref 2. Richmond, G. H., and Beardsley, G. D.: Nitrogen Mustard Therapy Complicated by Acute Renal Failure Due to Uric Acid Crystallization , Ann. Intern. Med. 39:1327-1332, 1953.Crossref 3. Kravitz, S. C.; Diamond, H. D., and Craver, L. F.: Uremia Complicating Leukemia Chemotherapy , J.A.M.A. 146:1595-1597, 1951.Crossref 4. Firmat, J.; Vanamee, P.; Klauber, L.;; Krakoff, I., and Randall, H. T.: The Artificial Kidney in the Treatment of Renal Failure and Hyperuricemia in Patients with Lymphoma and Leukemia , Cancer 13:276-282, 1960.Crossref 5. Handler, J. S.: The Role of Lactic Acid in the Reduced Excretion of Uric Acid in Toxemia of Pregnancy , J. Clin. Invest. 39:1526-1532, 1960.Crossref 6. Yü, T. F.; Sirota, J. H.; Berger, L.; Halpern, M., and Gutman, A. B.: Effect of Sodium Lactate Infusion on Urate Clearance in Man , Proc. Soc. Exp. Biol. Med. 96:809-813, 1957.Crossref 7. Maxwell, M. H.; Rockney, R. E.; Kleeman, C. R., and Twiss, M. R.: Peritoneal Dialysis: 1. Technique and Applications , J.A.M.A. 170:917-924, 1959.Crossref 8. Boen, S. T.: Kinetics of Peritoneal Dialysis: A Comparison with the Artificial Kidney , Medicine (Balt.) 40:243-287, 1961.Crossref 9. Knowlton, M.; Horner, W. H.; Seligson, D., and Iber, F. L.: Analytical Procedures , Washington, D.C., U.S. Army Medical Service Graduate School, Walter Reed Army Medical Center, 1955. 10. Peters, J. P., and Van Slyke, D. D.: Quantitative Clinical Chemistry , Vol. I, Baltimore, Williams & Wilkins Company, 1946, pp. 949-977. 11. Yü, T. F.; Berger, L.; Kupfer, S., and Gutman, A. B.: Tubular Secretion of Urate in the Dog , Amer. J. Physiol. 199:1199-1204, 1960. 12. Holland, J. F.; Sharpe, W.; Mamrod, L. M.; Dowd, E., and Hartsock, M.: Urate Excretion in Patients with Acute Leukemia , J. Nat. Cancer Inst. 23:1097-1105, 1959. 13. Gellhorn, A.; Friend, C.; Ultman, J. E., and Feigelson, P.: The Lymphomas: Combined Clinic , Ann. Intern. Med. 52:201-222, 1959. 14. Smith, H. W.: The Kidney , Fair Lawn, N.J., Oxford University Press, 1951, pp. 768-780. 15. Smith, W. W.; Finkelstein, N., and Smith, H. W.: Renal Excretion of Hexitols and Their Derivatives and Endogenous Creatinine-like Chromogen in Dog and Man , J. Biol. Chem. 135:231-250, 1940. 16. Dudley, H. A. F.; Batchelor, A. D. R., and Sutherland, A. B.: The Management of Haemoglobinuria in Extensive Burns , Brit. J. Plast. Surg. 9:275-285, 1957.Crossref 17. Schilling, J. A.; Ginn, H. E.; Richardson, W. R., and Dunlap, H. E.: A New Approach to the Fluid Therapy of the Severely Burned Patient: The Use of Urea as an Electrolyte Substitute , Ann. Surg. 150:756-767, 1959.Crossref 18. Barry, K. G.; Cohen, A., and LeBlanc, P.: Mannitolization: I. The Prevention and Therapy of Oliguria Associated with Cross-Clamping of the Abdominal Aorta , Surgery 50:335-340, 1961. 19. Barry, K. G.; Cohen, A.; Knochel, J. P.; Whelan, T. J., Jr.; Beisel, W. R.; Vargas, C. A., and LeBlanc, P. C., Jr.: Mannitol Infusion: II. The Prevention of Acute Functional Renal Failure During Resection of an Aneurysm of the Abdominal Aorta , New Engl. J. Med. 264:967-971, 1961.Crossref 20. Barry, K. G., and Malloy, J. P.: Oliguric Renal Failure: Evaluation and Therapy by the Intravenous Infusion of Mannitol , J.A.M.A. 179: 510-513, 1962.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Acute Uric Acid Nephropathy: Treatment with Mannitol Diuresis and Peritoneal Dialysis

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References (24)

Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1963.03620280052008
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Abstract

Abstract Hyperuricemia in patients with lymphoma and leukemia occurs spontaneously and as a complication of cytotoxic therapy. Increased urinary urate excretion may exceed the ability of the renal tubules to keep urates in solution: Acute renal failure secondary to urate crystallization in the kidneys and genitourinary tract is a sequel.1-3 In the past, if urine flow could not be maintained in the hyperuricemic patient by water loading and alkali therapy, procedures such as ureteral catheterization, nephrostomy, or hemodialysis were required to prevent death from acute renal failure.4 In two patients with severe hyperuricemia, azotemia, and oliguria unresponsive to water loading and alkali therapy, we have been able to avoid hemodialysis. The favorable result in their cases has prompted this report. Diuresis accompanied by lowering of serum uric acid and blood urea nitrogen levels to normal was secured in these patients by the intravenous infusion of the osmotic diuretic, mannitol. References 1. Gold, G. L., and Fritz, R. D.: Hyperuricemia Associated with the Treatment of Acute Leukemia , Ann. Intern. Med. 47:428-434, 1957.Crossref 2. Richmond, G. H., and Beardsley, G. D.: Nitrogen Mustard Therapy Complicated by Acute Renal Failure Due to Uric Acid Crystallization , Ann. Intern. Med. 39:1327-1332, 1953.Crossref 3. Kravitz, S. C.; Diamond, H. D., and Craver, L. F.: Uremia Complicating Leukemia Chemotherapy , J.A.M.A. 146:1595-1597, 1951.Crossref 4. Firmat, J.; Vanamee, P.; Klauber, L.;; Krakoff, I., and Randall, H. T.: The Artificial Kidney in the Treatment of Renal Failure and Hyperuricemia in Patients with Lymphoma and Leukemia , Cancer 13:276-282, 1960.Crossref 5. Handler, J. S.: The Role of Lactic Acid in the Reduced Excretion of Uric Acid in Toxemia of Pregnancy , J. Clin. Invest. 39:1526-1532, 1960.Crossref 6. Yü, T. F.; Sirota, J. H.; Berger, L.; Halpern, M., and Gutman, A. B.: Effect of Sodium Lactate Infusion on Urate Clearance in Man , Proc. Soc. Exp. Biol. Med. 96:809-813, 1957.Crossref 7. Maxwell, M. H.; Rockney, R. E.; Kleeman, C. R., and Twiss, M. R.: Peritoneal Dialysis: 1. Technique and Applications , J.A.M.A. 170:917-924, 1959.Crossref 8. Boen, S. T.: Kinetics of Peritoneal Dialysis: A Comparison with the Artificial Kidney , Medicine (Balt.) 40:243-287, 1961.Crossref 9. Knowlton, M.; Horner, W. H.; Seligson, D., and Iber, F. L.: Analytical Procedures , Washington, D.C., U.S. Army Medical Service Graduate School, Walter Reed Army Medical Center, 1955. 10. Peters, J. P., and Van Slyke, D. D.: Quantitative Clinical Chemistry , Vol. I, Baltimore, Williams & Wilkins Company, 1946, pp. 949-977. 11. Yü, T. F.; Berger, L.; Kupfer, S., and Gutman, A. B.: Tubular Secretion of Urate in the Dog , Amer. J. Physiol. 199:1199-1204, 1960. 12. Holland, J. F.; Sharpe, W.; Mamrod, L. M.; Dowd, E., and Hartsock, M.: Urate Excretion in Patients with Acute Leukemia , J. Nat. Cancer Inst. 23:1097-1105, 1959. 13. Gellhorn, A.; Friend, C.; Ultman, J. E., and Feigelson, P.: The Lymphomas: Combined Clinic , Ann. Intern. Med. 52:201-222, 1959. 14. Smith, H. W.: The Kidney , Fair Lawn, N.J., Oxford University Press, 1951, pp. 768-780. 15. Smith, W. W.; Finkelstein, N., and Smith, H. W.: Renal Excretion of Hexitols and Their Derivatives and Endogenous Creatinine-like Chromogen in Dog and Man , J. Biol. Chem. 135:231-250, 1940. 16. Dudley, H. A. F.; Batchelor, A. D. R., and Sutherland, A. B.: The Management of Haemoglobinuria in Extensive Burns , Brit. J. Plast. Surg. 9:275-285, 1957.Crossref 17. Schilling, J. A.; Ginn, H. E.; Richardson, W. R., and Dunlap, H. E.: A New Approach to the Fluid Therapy of the Severely Burned Patient: The Use of Urea as an Electrolyte Substitute , Ann. Surg. 150:756-767, 1959.Crossref 18. Barry, K. G.; Cohen, A., and LeBlanc, P.: Mannitolization: I. The Prevention and Therapy of Oliguria Associated with Cross-Clamping of the Abdominal Aorta , Surgery 50:335-340, 1961. 19. Barry, K. G.; Cohen, A.; Knochel, J. P.; Whelan, T. J., Jr.; Beisel, W. R.; Vargas, C. A., and LeBlanc, P. C., Jr.: Mannitol Infusion: II. The Prevention of Acute Functional Renal Failure During Resection of an Aneurysm of the Abdominal Aorta , New Engl. J. Med. 264:967-971, 1961.Crossref 20. Barry, K. G., and Malloy, J. P.: Oliguric Renal Failure: Evaluation and Therapy by the Intravenous Infusion of Mannitol , J.A.M.A. 179: 510-513, 1962.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Apr 1, 1963

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