Urgent increase in uric acid blood and acute urate kidney disease in cancer

Acute uric acidosis appears as a complication of rapid onset of melanoma, or by the treatment of severe melanoma in blood cancers such as leukemia, lymphoma, multiple myeloma.

Cancer is a chronic disease, but emergencies can occur as a complication of on-site invasive (spinal cord compression, upper venous thromboembolism, malignant leukemia, etc.) or birth due to systemic effects (hypercalcaemia, opportunistic infections, hypercoagulability, hyperuricemia, etc.). These complications can be signs of cancer and need to be documented and investigated.

General perception

Acute uric acidosis appears as a complication of rapid onset of malignant hypercalcemia, or by the treatment of severe melanoma in blood cancers such as leukemia, lymphoma, multiple myeloma. Moles with high nucleic acid metabolism such as acute leukemia, lymphoma may show elevated uric acid levels and are associated with renal failure. This problem may be due to the use of diuretics, reducing urate excretion. When patients have elevated blood uric acid, care should be taken to reduce the maximum uric acid before treatment for cancer. Patients with solid tumors need to be carefully monitored. Try uric acid phosphate, calcium, creatinine twice a day for the first 2-3 days of chemical treatment. If uric acid levels rise rapidly, there is a risk of acute kidney failure caused by the uric acid crystals in the distal, root canal and kidney tissue. Serum urate concentrations above 15 ng / l are a high risk of developing uric acid kidney disease. Rheumatoid arthritis is also a problem when patients have a history of gout.

Preventative treatment includes: reduction of uric source and increase of uric excretion in kidney. Antiopurinol is a competitive inhibitor of xanthin oxydase and prevents xanthin and hypoxanthin. The uric acid converts into insoluble uric acid. 12 to 24 hours before treatment with 600 mg, then 300 mg / day at high risk. Higher doses (up to 900 to 1200 mg / day) are used when elevated blood uric acid levels are due to the chemotherapy of patients taking anti-purine medications such as mercaptopurine or azathioprine. Only 25 - 35% of the calculated dose should be given if they are taking allopurinol. The reason is that this drug is also effective and also toxic. The secretion of uric acid is enhanced by maintaining the diuretic, and alkalinizing the urine to prevent uric acid crystallization. Alkaline diuretic to maintain water pH of nearly 7,

Emergency treatment

Acute uric acid elevation treatment includes: 1) supplementation of 2 to 4 liters of fluid a day; 2) Urinary alkalosis by 6-8g sodium bicarbonate a day; 3) allopurinol 900 - 1200mg / day; and 4) in severe cases of dialysis. When high uric acid levels are elevated, such treatment is unsuitable due to renal failure and low urine output. Allopurinol therapy has recently been shown to be better for patients with intolerance.

Patients with hyperuricemia often have a response to chemotherapy and have good prognosis. Therefore, active prevention should be indicated to avoid renal toxicity. Even if kidney failure occurs, dialysis may be needed, and kidney function may return to normal after the episode of endometriosis.