Patel Chinmay, Wilson Caitlin P, Ahmed Naveed, Hattab Yousef
University of Pikeville, Kentucky College of Osteopathic Medicine, Division of Nephrology, Pikeville Medical Center, USA.
Family Practice Residency Program, Pikeville Medical Center, USA.
Case Rep Nephrol. 2019 Feb 4;2019:4890287. doi: 10.1155/2019/4890287. eCollection 2019.
Acute hyperuricemia most commonly occurs in patients who experience tumor lysis syndrome. Hyperuricemia along with other electrolyte abnormalities like hyperkalemia, hypocalcemia, and hyperphosphatemia leads to acute kidney injury (AKI) due to acute uric acid nephropathy which is associated with significant morbidity. High risk patients are thus closely monitored for signs of these laboratory abnormalities. Extreme exercise, rhabdomyolysis, and seizures are rare causes of acute hyperuricemia. Serum uric acid level is not routinely monitored as a part of postictal labs. We report an unusual case of AKI in a young male with recurrent seizures and no associated rhabdomyolysis who was found to have acute uric acid nephropathy. Timely administration of Rasburicase prevented the need for dialysis in this patient and led to complete renal recovery. This case illustrates the importance of doing a urine microscopy and checking uric acid level in patients with recurrent seizures who develop unexplainable AKI, as timely management helps improve outcome. We also briefly review the pathophysiology of seizure related hyperuricemia and acute uric acid nephropathy.
急性高尿酸血症最常见于发生肿瘤溶解综合征的患者。高尿酸血症与其他电解质异常（如高钾血症、低钙血症和高磷血症）一起，由于急性尿酸肾病导致急性肾损伤（AKI），这与显著的发病率相关。因此，对高危患者密切监测这些实验室异常的体征。剧烈运动、横纹肌溶解和癫痫发作是急性高尿酸血症的罕见病因。血清尿酸水平不作为发作后实验室检查的常规项目进行监测。我们报告了一例年轻男性急性肾损伤的罕见病例，该患者有反复发作的癫痫且无相关横纹肌溶解，被发现患有急性尿酸肾病。及时给予拉布立酶避免了该患者进行透析的需要，并使其肾功能完全恢复。该病例说明了对于出现无法解释的急性肾损伤且反复发作癫痫的患者，进行尿显微镜检查和检查尿酸水平的重要性，因为及时治疗有助于改善预后。我们还简要回顾了癫痫相关高尿酸血症和急性尿酸肾病的病理生理学。
