nephropathy

Definition of uric acid nephropathy

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Uric acid nephropathy is a condition of kidney damage that occurs when there is too much uric acid in the body. When the uric acid is too high, crystals can form in the tissues of the body. When this happens in the kidneys, it is called gouty or uric acid nephropathy.

Types of renal diseases induced by uric acid or urate crystal deposition

● Acute uric acid nephropathy (UAN)
Acute UAN: Precipitated by renal tubular obstruction resulting from acute massive elevation of serum uric acid, often owing to cell lysis during induction chemotherapy or radiation; furthermore, crystallization of uric acid or calcium phosphate in renal tubules affects renal function.

● Chronic urate nephropathy

Renal insufficiency attributed to parenchymal damage secondary to medullary urate deposition; effect of hyperuricemia on development and progression of chronic renal disease in humans is largely unknown. Studies in animals have shown an association between hyperuricemia and intrarenal vascular disease

● Uric acid nephrolithiasis

Seen most commonly in patients with underlying hyperuricemia or gout who have abnormally low urine pH owing to low ammonia excretion:Frequency of stone formation increases with increasing serum uric acid levels andurinaryuric acid excretion rates.

Causes

As we know, the cause of Uric Acid Nephropathy is high uric acid. However, why patients have high uric acid? And how can it lead to kidney disease?

● Diet and Healthy Condition

Uric acid relates with purines in the diet. If patients intake too much uric acid or they can’t eliminate it timely and clearly, more and more uric acid crystal will occur in the blood.

● Poor Immune System

Because the disorder of immune system, immune complex will do harm to kidneys. Because of the infection by infectious agent in blood, inflammation happens in the wound of cells in blood vessels. In this case, blood vessels are damaged easily. Because of the infections, inflammation will affect the body health with the blood circulation.

Uric acid nephrolithiasis can be caused by any underlying disorder that causes hyperuricosuria. This includes all of the previously mentioned causes of acute uric acid nephropathy, such as malignancy, hypercatabolic states, and the hereditary enzyme deficiencies.

● Uric acid stones develop in 20% of people with gout.

● Acute diarrheal states may increase urinary uric acid concentration through excessive water loss and dehydration, leading to stone formation.

● Aspirin and probenecid augment uric acid secretion and may lead to stone formation, especially in people with a purine-rich diet.

he treatment is aimed at stopping the immediate problems and preventing them from coming back. It is also for the prevention of complications which come from longstanding gout or high uric acid in the tissues. There are some treatments different from each other in many aspects.

• Mediation

Curtailing dietary purine, chiefly in the form of animal protein, can substantially decrease uric acid production. Increasing fluid intake to maintain a urine output of 2-3 L/d can be achieved with minimal inconvenience. Ingestion of alkali in the form of bicarbonate or citrate at a dose of 0.5-1.5 mEq/kg/d, with the goal of a urinary pH of 6.0-6.5, can be effective. The significant toxicity of allopurinol and the lifelong expense of using it make this therapy unwarranted. The emphasis should be on controlling other risk factors for kidney failure, such as diabetes and hypertension.

• Extracorporeal shock wave lithotripsy(ESWL)

Extracorporeal shock wave lithotripsy(ESWL) can be tried for problem calculi, but the procedure is less effective for uric acid stones than for other types of stones.

• Dialysis

If the start of kidney failure has been sudden and more severe, dialysis may be used. Prior to the dialysis era, treatment of acute uric acid nephropathy was not very successful, with mortality rates approaching 50%. As a result of the use of modern treatment, including prophylaxis and dialysis, uric acid nephropathy has become rare. Additionally, when it does occur, the prognosis for the acute renal failure is excellent. Management without dialysis involves attempts to lower the plasma urate level and the urate concentration within the renal tubules.

• Treatment in our hospital

Our hospital’s treatment is different with the conventional treatment. The traditional treatment is often directed against proteinuria, hematuria, etc. We directly eliminate the root cause, that is, the repair of the epithelial cells .

Therapeutic measure is the integrated use of vasodilator, anti-inflammation , anticoagulant and degradation of harmful substances. In the use of drugs , we are not simply using Chinese or Western medicines, but to increase the intensity of Chinese medicine treatment on the basis of Western medicine treatment. In addition, our hospital developed hospital preparations to improve the efficacy of Chinese-Western medicine, playing a very important coordinating role in the treatment process. Therefore, our treatment effects are very different. We call it: Micro-Chinese medicine infiltration method of renal fibrosis. Practices proves that this treatment method to repair renal tubular capillary epithelial cell is effective. We can determine: once the damaged epithelial cells are repaired , the condition will be improved. So epithelial cells will certainly recover its function and proteinuria , hematuria will naturally disappear. The probability of recurrence will surely be reduced.