Showing posts with label uric acid. Show all posts
Showing posts with label uric acid. Show all posts

Thursday, August 18, 2011

Topic Discussion: Uromodulin Associated Kidney Disease


1.A disease entity called family juvenile hyperuricemic nephropathy or medullary cystic kidney disease type 2 is something that we rarely encounter.  It is also called uromodulin storage or uromulin associated kidney disease.
2.Clinically: Uric acid associated damages- tophi, gout and ultimately chronic renal damage leading to dialysis by 4th decade. 
3. Chromosome 16p12 ( autosomal dominant)
4. It's a reduced excretion problem of urate( unclear why?)
5. Diagnosis can be made:- history of childhood gout, renal insuff without hematuria or proteinuria and bland urine sediment and family history of gout
6. Renal US might reveal cysts but NOT always
7. Allopurinol and ACEI or ARB treatment are only potential supportive measures.

Some interesting work is being done at certain centers around the country
Look at the lists below:
Ref:

Friday, August 5, 2011

Consult Rounds: High Uric Acid

Uric acid elevations are frequently noted in patients with renal insufficiency as a clearance related problem.
We also note seriously high uric acid levels in patients with tumor lysis syndromes or large tumor burdens.
HCTZ can also do it.


What about tissue hypxia? Changes in oxygen tension has been associated with modulation of purine turnover.  
Rat and human studies have shown that uric acid levels in hypoxia are much higher than normoxia and hyperoxia.  There is a correlation that hypoxia results in greater purine catabolism and leading to increased production of uric acid. Hence we often see lactate levels correlating well with uric acid levels in sepsis.

Few ref:

http://www.ncbi.nlm.nih.gov/pubmed/8470901
http://www.ncbi.nlm.nih.gov/pubmed/20730463
http://www.ncbi.nlm.nih.gov/pubmed/17067515
http://www.ncbi.nlm.nih.gov/pubmed/17269363

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