Abstract: FR-PO035

An Uncommon Presentation of Acute Uric Acid Nephropathy

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Lee-Mulay, Anna J, University of Wiconsin, Madison, Wisconsin, United States
  • Bhutani, Gauri, University of Wisconsin, Madison, Wisconsin, United States
Background

Secondary hyperuricemia from ineffective erythropoiesis can be seen in myeloproliferative disorders. Uric acid (UA) crystal precipitation may cause acute tubular injury and urinary obstruction in this rare disease group but is not commonly described in myelofibrosis (MF).

Methods

A 68-year-old male with essential thrombocythemia & secondary MF diagnosed 6 years ago, who has been on ruxolitinib for 2 years with a dose increase within the last 3 months, presented with a few hours of nausea and vomiting following a fall 1 day prior. Serum creatinine (S.Cr) was 2.71 mg/dL (baseline 1.1 mg/dL). A CT abdomen pelvis showed gravel layers within bladder & distal ureters with resultant bilateral hydroureter & pelviectesis. Serum UA was 19.4 mg/dL. Cystoscopy showed stone debris (100% UA) & bilateral ureteral stents were placed. S.Cr increased to 4.5 mg/dL over next 2 days with UA still >15 mg/dL despite intravenous hydration, urinary alkalinization & initiation of allopurinol. Rasburicase (2 doses of 3 mg IV) was started next with prompt renal recovery & normalization of UA levels. Now, 6 months later, S.Cr is 1.06 mg/dL, UA 7.1 mg/dL, on allopurinol 300 mg daily.

Conclusion

Acute UA nephropathy is only rarely described in MF, especially in secondary MF. Hyperuricemia has not been described with use of JAK2 inhibitor ruxolitinib, although it is not clear if & how much this medication contributed to the above presentation. Our case highlights that UA related renal diseases should be an important consideration in all myeloproliferative disorders. Timely intervention with rapid uric acid lowering is needed for renal recovery.

UA gravel within urinary bladder

bilateral hydronephrosis from UA debris in urinary collecting system