Uric Acid Nephropathy Differential Diagnoses

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

Establishing the diagnosis of acute uric acid nephropathy is sometimes complicated by the variety of nephrotoxic drugs, radiographic studies, and associated clinical problems often observed during the early presentation of malignancies. Dehydration, contrast nephropathy, and acute tubular necrosis caused by nephrotoxic drugs or sepsis-related renal failure must be considered in this high-risk population.

Renal complications associated with malignancies that may result in the sudden cessation of kidney function include hypercalcemia; tumor infiltration of the kidneys, ureter, or bladder; and the monoclonal gammopathies, which may cause a myeloma-type kidney disorder. In addition, chemotherapeutic agents may produce nephropathy with a secondary elevation of urate levels. Other causes of elevated urate levels are preexisting renal failure and drugs, including diuretics, salicylates (< 2 g/d), ethambutol, pyrazinamide, vitamin A, cyclosporine, and tacrolimus.

The differential diagnosis for chronic urate nephropathy includes alternative etiologies of chronic renal insufficiency, including diabetes, hypertension, atherosclerotic disease, and primary glomerular diseases. Environmental lead poisoning is another consideration in a patient with hypertension, gout, hyperuricemia, and chronic kidney disease. [16]

Other metabolic stone diseases can mimic uric acid nephrolithiasis, and hyperuricosuria is a known risk factor for calcium stone formation.