Uric Acid Nephropathy Clinical Presentation

Updated: Sep 10, 2019
  • Author: Mark T Fahlen, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

Acute uric acid nephropathy is usually observed in patients shortly after presentation for acute neoplastic disorders or within 1-2 days of initiation of chemotherapy. The most frequently observed symptoms are nausea, vomiting, lethargy, and seizures.

A history consistent with chronic urate nephropathy is progressive renal failure in a patient with coexisting gout or uric acid nephrolithiasis and no other identifiable cause for renal failure. Hypertension is common, and pyelonephritis may complicate the presence of obstructing calculi.

Uric acid nephrolithiasis should be considered in a patient with a history of gout who presents with flank pain, urinary frequency, and dysuria. Hematuria is also common. However, note that uric acid nephrolithiasis often precedes the onset of gouty arthritis in patients with both conditions.

Much debate exists regarding the incidence of chronic urate nephropathy; the presence of another comorbidity, such as diabetes or hypertension, often provides a better explanation for the renal insufficiency.

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Physical Examination

Occasionally, ureteral obstruction from uric acid sludge can cause severe flank pain, abdominal pain, and dysuria.

Oliguria is the primary sign of the onset of urate nephropathy, with edema and congestive heart failure occurring subsequently.

The well-recognized clinical entity of various combinations of hyperuricemia, azotemia, hyperkalemia, hyperphosphatemia, lactic acidosis, and hypocalcemia is known as tumor lysis syndrome.

The physical examination may reveal subcutaneous tophi or the typical arthritic changes of gout.

 

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