Kikuchi Y, Koga H, Yasutomo Y, Kawabata Y, Shimizu E, Naruse M, Kiyama S, Nonoguchi H, Tomita K, Sasatomi Y, Takebayashi S
Department of Internal Medicine, Kumamoto Hospital, Self-Defense-Force, Japan.
Clin Nephrol. 2000 Jun;53(6):467-72.
We here report the case of a 38-year-old male with back pain and vomiting occurring after exercise. Serum creatinine level was elevated, and he was admitted to our hospital with diagnosis of acute renal failure (ARF). He had experienced similar attacks at least 4 times, including the present episode, from the age of 22 years. After admission, the patient was managed only by resting, and remission was nearly attained in about 1 month. The renal biopsy specimen performed on day 15 showed findings of acute tubular necrosis, thickening of the tubular basement membrane, and interstitial fibrosis. After remission, the serum uric acid level was 0.7-0.8 mg/dl, fractional excretion of uric acid was 0.63, and the possibility of other diseases facilitating the excretion of uric acid was denied. Therefore, ARF associated with idiopathic renal hypouricemia was diagnosed. Since only mild responses were observed in a pyradinamide loading test and a benzbromarone loading test, the case was considered to be a presecretary reabsorption disorder type. Renal function tests showed the almost complete recovery of the glomerular filtration rate (GFR: 114 ml/min/1.73 m2), but the urine concentrating ability was markedly decreased (specific gravity 1.019 and osmolarity 516 mOsm/kgxH2O in Fishberg test). Past data from this patient indicated that this renal dysfunction had been persisting for ten years. We examined 9 patients with renal hypouricemia and focused on the differences between the two groups (with or without complications). Four patients had a history of exercise-induced ARF or calculus. The urine concentrating ability was significantly lower in these patients (group A) than in the other patients without complications (group B). The glomerular filtration rate in group A was within the normal range, but was lower than in group B. These results suggested the possibility that patients with renal hypouricemia with complications may have chronic renal dysfunction in the future.
我们在此报告一例38岁男性患者，其在运动后出现背痛和呕吐症状。血清肌酐水平升高，他因急性肾衰竭（ARF）被收治入院。自22岁起，包括此次发作在内，他至少经历过4次类似发作。入院后，患者仅通过休息进行治疗，约1个月后病情几乎缓解。第15天进行的肾活检标本显示有急性肾小管坏死、肾小管基底膜增厚和间质纤维化的表现。缓解后，血清尿酸水平为0.7 - 0.8mg/dl，尿酸排泄分数为0.63，排除了其他促进尿酸排泄的疾病可能性。因此，诊断为与特发性肾性低尿酸血症相关的ARF。由于在吡嗪酰胺负荷试验和苯溴马隆负荷试验中仅观察到轻微反应，该病例被认为是分泌前期重吸收障碍型。肾功能检查显示肾小球滤过率几乎完全恢复（GFR：114ml/min/1.73m²），但尿液浓缩能力明显下降（Fishberg试验中比重为1.019，渗透压为516mOsm/kgxH₂O）。该患者过去的数据表明这种肾功能障碍已持续十年。我们检查了9例肾性低尿酸血症患者，并关注两组（有或无并发症）之间的差异。4例患者有运动诱发ARF或结石病史。这些患者（A组）的尿液浓缩能力明显低于无并发症的其他患者（B组）。A组的肾小球滤过率在正常范围内，但低于B组。这些结果提示有并发症的肾性低尿酸血症患者未来可能存在慢性肾功能障碍的可能性。
