Abstract
Although hyperuricemia has been found in a large number of disorders, (1) its occurrence in the hemolytic uremic syndrome (HUS) is not generally appreciated. (2,3) In 1969, while performing studies of the transperitoneal movement of solute (4) (including uric acid) in children undergoing their initial dialysis, we observed marked hyperuricemia disproportionate to the degree of renal failure in two infants with HUS. We have subsequently confirmed these observations in a series of 26 children with HUS and have performed studies in rabbits in an effort to identify the mechanism(s) leading to hyperuricemia. This report has four objectives: 1) to review our experience with and interpretation of uric acid metabolism in patients with HUS, 2) to present data which provide information on possible mechanisms for the hyperuricemia, 3) to consider uric acid metabolism in experimental models of hemolysis and acute and chronic renal failure, and 4) to review available literature on the subject of uric acid metabolism in renal failure.
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References
Prebis, J.W., Gruskin, A-.B., Polinsky, M.S. and Baluarte, H.J.: Uric acid in childhood essential hypertension. Proc. Fifth Int. Ped. Neph. Symp., Martinus Nijhoff, pp. 122-126, ed. Gruskin, A.B. and Norman, M.E., 1980.
Naiman, J.L., Mellon, M. and Gruskin, A.B.: Disproportionate hyperuricemia in hemolysis associated with renal failure. Abst. Soc. Pediatr. Res. May, 1970.
Kaplan, B.S., and Thomson, P.D.: Hyperuricemia in the hemolytic-uremic syndrome. Am J Dis Child., 130: 854, 1976.
Gruskin, A.B., and Cote, M.L.: Kinetics of Peritoneal Dialysis in Children. Abst. Soc. Ped. Res. 1970, p. 44.
Stapleton, F.B., Linshaw, M.A., Hassanein, K. and Gruskin, A.B.: Uric acid excretion in normal children. J. Pediatr. 92: 911, 1978.
Harkness, R.A. and Nicol, A.D.: Plasma uric acid levels in children. Arch. Dis. Child., 44: 773, 1969.
Ponder, E.: Hemolysis and Related Phenomena. Grune and Stratton 1948, p. 362.
Seller, R.A., Forman, E.N., Bolger, J.F., Abildgaard, C.F., and Schulmann, I.: Induction of intravascular coagulation and renal cortical necrosis in rabbits by simultaneous injection of thorotrast and endotoxin. Brit J Haemat., 16; 501, 1969.
Steele, T-H : Control of uric acid excretion. N Engl J Med., 284: 1193, 1971.
Steele, T.H. and Rieselbach: The renal mechanism for urate homeostasis in normal man. Am J Med., 43: 868, 1967.
Francoise, R-R., and Weiner, I.M.: Renal excretion of urate: Factors determining the action of drugs. Kidney Int., 18: 665, 1980.
Jorgensen, S. and Nielsen, A.A.: Uric acid in human blood corpuscles and plasma. Scand. J. Lab. & CLin. Med. 8: 108, 1956.
Bishop, C., Rankine, D.M. and Talbott, H.J,: The nucleotides in normal human blood. J. Biol. Chem. 234: 1233, 1959.
Fong, J.S.C., de Chadarevian, J-P, and Kaplan, B.S.: Hemolytic Uremic Syndrome. Pediatr Clin. N. Amer. 29: 835, 1982.
Adler, R., Robinson, R., Pazdral, P., and Grushkin, C.: Hyperuricemia in diarrheal dehydration. Am J Dis Child., 136: 211, 1982.
Alderman, M.H., Davis, R.P.: Hyperuricemia in starvation. Proc. Soc.Exp. Biol. Med., 118: 790, 1965.
Warren, D.J.: Hyperuricemic acute renal failure after epileptic seizures. Lancet 2: 385, 1975.
Klinenberg, J.R., Kippen, I., and Bluestone, R.: Hyperuricemic nephropathy: Pathologic features and factors influencing urate deposition. Nephron 14: 88, 1975.
Kjellstrand, C.M., Campbell, D.C.,II., von Hartizsch, H.B. and Buselmeier, T.J.: Hyperuricemic acute renal failure. Arch. Intern. Med. 133: 349, 1974.
Ferris, T.F. and Gorden, P.: Effect of angiotensin and norepinephrine upon urate clearance in man. Am.J.Med., 44: 359, 1968.
Senekjian, H.O., Knight, T.F., Sansom, S.C. and Weinman, E.J.: Effect of flew rate and the extracellular fluid volume on proximal urate and water absorption. Kidney Int. 17: 155, 1980.
Steele, T.H., Oppenheimer, S.: Factors affecting urate excretion following diuretic administration in man. Am. J. Med. 47: 564, 1969.
Yu, T.F., Sirota, J.H., Berger, L., et al.: Effect of sodium lactate infusion on urate clearance in man. Proc. Soc. Exp. Biol. Med. 96: 809, 1957.
Goldfinger, S., Klinenberg, J.R. and Seegmiller, J.E.: Renal retention of uric acid induced by infusion of beta-hydroxybutyrate and acetoacetate. N. Engl. J. Med. 272: 351, 1965.
Chennavasin, P., Seiwell, R., Brater, D.C. and Liang, W.M.: Pharmacodynamic analysis of the furosemide-probenecid interaction in man. Kidney Int. 16: 187, 1979.
Oliva, P.B.: Lactic acidosis. Am. J. Med. 48: 209, 1970.
Orringer, E.P., Weiss, F.R. and Preuss, H.G.: Azotemic inhibition of organic anion transport in the kidney of the rat: mechanisms and characteristics. Clin. Sci. 40: 159, 1971.
Steele, T.H., and Rieselbach, R.E.: The contribution of residual nephrons within the chronically diseased kidney to urate homeostasis in man. Am. J„ Med., 43: 876, 1967.
McPhaul, J.J., Jr.: Hyperuricemia and urate excretion in chronic renal disease. Metabolism, 17: 430, 1968.
Diamond, H. and Meisel, A.: Influence of volume expansion, serum sodium, and fractional excretion of sodium on urate excretion. Pfluegers Arch. 356: 47, 1975.
Steele, T.H.: Evidence of altered renal urate reabsorption during changes in volume of the extracellular fluid. J. Lab. Clin. Med. 74: 288, 1969.
Weinman, E.J., Eknoyan, G. and Suki, W.N.: The influence of extracellular fluid volume on the tubular reabsorption of uric acid. J. Clin. Invest. 55: 283, 1975.
Sorensen, L.B.: Role of the intestinal tract in the elimination of uric acid. Arthritis Rheum. 8: 695, 1965.
Cannon, P.J., Svahn, D.S., Demartini, F.E.: The influence of hypertonic saline infusions upon the fractional reabsorption of urate and other ions in normal and hypertensive man. Circulation 41: 97, 1970.
Prebis, J.W., Gruskin, A.B., Polinsky, M.S., Baluarte, H. J.: Uric acid in childhood essential hypertension. J. Pediatr. 98: 702, 1981.
Dollery, C.T., Duncan, H. and Schumer, B.: Hyperuricemia related to treatment of hypertension. Brit. Med. J. 2: 832, 1960.
Cannon, P.J., Stason, W.B., DeMartini, F.E., et al.: Hyperuricemia in primary and renal hypertension. N. Engl. J. Med. 275: 457, 1966.
Chodorcwski, Z., Rynkiewicz, H., and Manitius, A.: Serum uric acid levels and urinary uric acid excretion in patients with polycystic kidney disease. Clin. Res. 26: 460A, 1978.
Messerili, F.H., Frohlich, E.D., Dreslinski, G.R., Suarez, D.H., Artistimuno, G.G.: Serum uric acid in essential hypertension: an indicator of renal involvement. Ann.Intern.Med. 93:, 817, 1980.
Grunfeld, B., Gimenez, M., Liapchuc, S., et al.: Systemic hypertension and plasma renin activity in children with the hemolytic uremic syndrome. Int. J. Pediatr. Neph. 3: 211, 1982.
Gold, G.L. and Fritz, R.D.: Hyperuricemia associated with the treatment of acute leukemia. Ann. Intern. Med. 47: 428, 1957.
Viozzi, F.J., Bluhm, G.B, Riddle, J.M.: Gout and arterial thrombosis. Henry Ford Hosp. Med.J. 20: 119, 1972.
Bluhm, G.B., Riddle, J.M.: Platelets and vascular disease in gout. Semin. Arthritis Rheum. 2: 355, 1973.
Streitman, K., Boda, D., Eck, E. and Magori, A.: Pathological importance of hyperuricemia and possibility of allopurinol therapy in experimental disseminated intravascular coagulation. Int. J. Ped. Neph. 2: 136, 1981.
Epstein, F.H. and Pigeon, G.: Experimental urate nephropathy: Studies on the distribution of urate in renal tissue. Nephron 1: 144, 1964.
Smith, J.F. and Lee, Y.C.: Experimental uric acid nephritis in the rabbit. J. Exp. Med. 105, 615, 1957.
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© 1984 Martinus Nijhoff Publishing, Boston
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Gruskin, A.B. et al. (1984). Uric Acid Perturbations in the Hemolytic Uremic Syndrome. In: Strauss, J. (eds) Acute Renal Disorders and Renal Emergencies. Developments in Nephrology, vol 7. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3822-2_4
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