Ichida K, Hikita M, Hosoya T
Jikei University School of Medicine, Second Department of Internal Medicine.
Nihon Rinsho. 1996 Dec;54(12):3277-82.
The risk for renal insufficiency by uric acid precipitation in medulla of kidney correlates with the degree of uric acid supersaturation in the urine, depending on uric acid concentration and urinary pH. The patients with gout or hyperuricemia have sometimes acidic urine and increased uric acid excretion. Accordingly, these patients frequently accompany by renal insufficiency. Improvement of hyperuricosuria, increasing of urine volume, and alkalinization of urine to pH6 6.5, are effective for the prevention from renal insufficiency. Acute renal failure related to hyperuricemia, can also occured secondary to cell lysis. Tumor lysis syndrome is a critical illness characterized by massive tumor cell death leading to severe hyperuricemia, hyperphosphatemia, hypocalcemia, and acute renal failure after starting chemotherapy to cancers, especially lymphoproliferative malignancies. Administration of allopurinol 500-600 mg and adequate hydration and alkalinization of urine are advocated to prevent acute renal failure. Intensive care with hemodialysis is often required to treat renal failure, because renal failure is reversible in most cases.
尿酸在肾髓质沉淀导致肾功能不全的风险与尿液中尿酸过饱和程度相关，这取决于尿酸浓度和尿液pH值。痛风或高尿酸血症患者有时尿液呈酸性且尿酸排泄增加。因此，这些患者常伴有肾功能不全。改善高尿酸尿症、增加尿量以及将尿液碱化至pH值6 - 6.5，对预防肾功能不全有效。与高尿酸血症相关的急性肾衰竭也可继发于细胞溶解。肿瘤溶解综合征是一种危重症，其特征为大量肿瘤细胞死亡，导致在癌症化疗开始后，尤其是淋巴增殖性恶性肿瘤化疗后，出现严重的高尿酸血症、高磷血症、低钙血症和急性肾衰竭。主张给予500 - 600毫克别嘌醇，并充分补液和碱化尿液以预防急性肾衰竭。由于大多数情况下肾衰竭是可逆的，治疗肾衰竭通常需要进行血液透析的重症监护。
