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Kidney Week

Abstract: PO0036

Seizure-Induced Hyperuricemia and Associated Urate Nephropathy: A Prospective Cohort Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Cote, Jean Maxime, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
  • Bollee, Guillaume, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
Background

Urate nephropathy is an uncommon cause of acute kidney injury (AKI). Although most factors are associated with tumor lysis syndrome and rhabdomyolysis, occurrence following severe seizure has also been described. There are effective ways to prevent and treat urate-associated AKI, when adequately identified. However, uric acid measurement following convulsion episodes is rarely performed and therefore, the incidence of hyperuricemia in this context is unknown. Our objective was to quantify these metabolic disturbances following severe generalised tonic-clonic seizures (GTCS).

Methods

We prospectively recruited patients admitted in our hospital for severe GTCS (≥5 min or a series of seizures with an incomplete return to baseline) and described the kinetics of serum uric acid, creatinine, creatine kinase and lactate during a 72h follow-up. Urine urate-to-creatinine ratio was used to monitor urate tubular toxicity.

Results

From August 2018 to September 2019, 13 patients with a median GTCS duration of 5.0 minutes (IQR 2.0-12.5) were included. The median serum uric acid was initially 346.0 μmol/L (IQR 155.0-377.5) and decreased to 178.0 μmol/L (IQR 140.0-297.5), while serum creatinine passed from 73.0 μmol/L (IQR 151.0-80.0) to 57.0 μmol/L (IQR 44.0-70.0) over follow-up (Figure). AKI occurred in 4 patients (KDIGO Stage ≥1).

Conclusion

Serum uric acid levels increase acutely following a severe GTCS than return to baseline within 3 days. During that period, there is an increased risk of AKI that might be associated with urate nephropathy. To quickly identify and manage patients at risk of acute hyperuricemia and related complications, measurement of uric acid following a GTCS might be beneficial.

Figure. Post-seizure laboratory values for each participant. Star dots are the maximal value of creatinine where AKI was diagnosed.

Funding

  • Clinical Revenue Support