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Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome

Identifieur interne : 004676 ( Main/Exploration ); précédent : 004675; suivant : 004677

Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome

Auteurs : Vin-Cent Wu [Taïwan] ; Jenq-Wen Huang [Taïwan] ; Po-Ren Hsueh [Taïwan] ; Ya-Fei Yang [Taïwan] ; Hung-Bin Tsai [Taïwan] ; Wei-Chih Kan [Taïwan] ; Hong-Wei Chang [Taïwan] ; Kwan-Dun Wu [Taïwan]

Source :

RBID : PMC:7115701

Abstract

Background: The purpose of this study is to determine the incidence and significance of hypouricemia in patients with severe acute respiratory syndrome (SARS). Pulmonary lesions in patients with SARS are thought to result from proinflammatory cytokine dysregulation. Acute renal failure has been reported in patients with SARS, but whether cytokines can injure renal tubules is unknown. Methods: Sixty patients diagnosed with SARS in Taiwan in April 2003 were studied. Patients were identified as hypouricemic when their serum uric acid (UA) level was less than 2.5 mg/dL (<149 μmol/L) within 15 days after fever onset. Urine UA and creatinine levels were available for 43 patients; the serum cytokines interleukin-6 (IL-6), IL-8, and tumor necrosis factor-α (TNF-α) were measured in 16 patients. Results: Sixteen patients (26.7%) had hypouricemia (UA, 1.68 ± 0.52 mg/dL [100 ± 31 μmol/L]). No differences in age, sex, symptoms, vital signs, hemogram, or other biochemistry data existed between the hypouricemic and normouricemic groups. Fractional excretion (FE) of UA (FEUA) in 12 hypouricemic patients was 39.6% ± 23.4%, significantly greater than that of 31 normouricemic patients (16.4% ± 11.4%; P < 0.0001). After adjustments for age and sex, high FEUA was significantly associated with the lowest blood oxygenation (P = 0.001; r = −0.624). The number of catastrophic outcomes (endotracheal intubation and/or death) adjusted for older age and sex showed that hypouremic patients had an odds ratio of 10.57 (confidence interval, 2.33 to 47.98; P = 0.002). Kaplan-Meier curves for catastrophic outcome–free results showed significant differences between patients with normouricemia or hypouricemia (P = 0.01). Serum IL-8 levels correlated significantly with FEUA (P < 0.001; r = 0.785) and inversely with serum UA level (P = 0.044; r = −0.509); neither IL-6 nor TNF-α level showed such correlations. Conclusion: One fourth of patients with SARS developed hypouricemia, which might result from a defect in renal UA handling and was associated with a high serum IL-8 level. Renal hypouricemia is an ominous sign in patients with SARS.


Url:
DOI: 10.1053/j.ajkd.2004.09.031
PubMed: 15696447
PubMed Central: 7115701


Affiliations:


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Le document en format XML

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<nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff>
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<name sortKey="Huang, Jenq Wen" sort="Huang, Jenq Wen" uniqKey="Huang J" first="Jenq-Wen" last="Huang">Jenq-Wen Huang</name>
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<nlm:aff id="aff3">Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff>
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<wicri:noRegion>Taipei</wicri:noRegion>
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<name sortKey="Yang, Ya Fei" sort="Yang, Ya Fei" uniqKey="Yang Y" first="Ya-Fei" last="Yang">Ya-Fei Yang</name>
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<name sortKey="Tsai, Hung Bin" sort="Tsai, Hung Bin" uniqKey="Tsai H" first="Hung-Bin" last="Tsai">Hung-Bin Tsai</name>
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<nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff>
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<name sortKey="Kan, Wei Chih" sort="Kan, Wei Chih" uniqKey="Kan W" first="Wei-Chih" last="Kan">Wei-Chih Kan</name>
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<name sortKey="Chang, Hong Wei" sort="Chang, Hong Wei" uniqKey="Chang H" first="Hong-Wei" last="Chang">Hong-Wei Chang</name>
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<nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
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<name sortKey="Wu, Kwan Dun" sort="Wu, Kwan Dun" uniqKey="Wu K" first="Kwan-Dun" last="Wu">Kwan-Dun Wu</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, National Taiwan University Hospital, Taipei</wicri:regionArea>
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<title level="j">American Journal of Kidney Diseases</title>
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<div type="abstract" xml:lang="en">
<p>
<italic>
<underline>Background:</underline>
</italic>
The purpose of this study is to determine the incidence and significance of hypouricemia in patients with severe acute respiratory syndrome (SARS). Pulmonary lesions in patients with SARS are thought to result from proinflammatory cytokine dysregulation. Acute renal failure has been reported in patients with SARS, but whether cytokines can injure renal tubules is unknown.
<italic>
<underline>Methods:</underline>
</italic>
Sixty patients diagnosed with SARS in Taiwan in April 2003 were studied. Patients were identified as hypouricemic when their serum uric acid (UA) level was less than 2.5 mg/dL (<149 μmol/L) within 15 days after fever onset. Urine UA and creatinine levels were available for 43 patients; the serum cytokines interleukin-6 (IL-6), IL-8, and tumor necrosis factor-α (TNF-α) were measured in 16 patients.
<italic>
<underline>Results:</underline>
</italic>
Sixteen patients (26.7%) had hypouricemia (UA, 1.68 ± 0.52 mg/dL [100 ± 31 μmol/L]). No differences in age, sex, symptoms, vital signs, hemogram, or other biochemistry data existed between the hypouricemic and normouricemic groups. Fractional excretion (FE) of UA (FE
<sub>UA</sub>
) in 12 hypouricemic patients was 39.6% ± 23.4%, significantly greater than that of 31 normouricemic patients (16.4% ± 11.4%;
<italic>P</italic>
< 0.0001). After adjustments for age and sex, high FE
<sub>UA</sub>
was significantly associated with the lowest blood oxygenation (
<italic>P</italic>
= 0.001;
<italic>r</italic>
= −0.624). The number of catastrophic outcomes (endotracheal intubation and/or death) adjusted for older age and sex showed that hypouremic patients had an odds ratio of 10.57 (confidence interval, 2.33 to 47.98;
<italic>P</italic>
= 0.002). Kaplan-Meier curves for catastrophic outcome–free results showed significant differences between patients with normouricemia or hypouricemia (
<italic>P</italic>
= 0.01). Serum IL-8 levels correlated significantly with FE
<sub>UA</sub>
(
<italic>P</italic>
< 0.001;
<italic>r</italic>
= 0.785) and inversely with serum UA level (
<italic>P</italic>
= 0.044;
<italic>r</italic>
= −0.509); neither IL-6 nor TNF-α level showed such correlations.
<italic>
<underline>Conclusion:</underline>
</italic>
One fourth of patients with SARS developed hypouricemia, which might result from a defect in renal UA handling and was associated with a high serum IL-8 level. Renal hypouricemia is an ominous sign in patients with SARS.</p>
</div>
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<country>
<li>Taïwan</li>
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<name sortKey="Wu, Vin Cent" sort="Wu, Vin Cent" uniqKey="Wu V" first="Vin-Cent" last="Wu">Vin-Cent Wu</name>
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<name sortKey="Chang, Hong Wei" sort="Chang, Hong Wei" uniqKey="Chang H" first="Hong-Wei" last="Chang">Hong-Wei Chang</name>
<name sortKey="Hsueh, Po Ren" sort="Hsueh, Po Ren" uniqKey="Hsueh P" first="Po-Ren" last="Hsueh">Po-Ren Hsueh</name>
<name sortKey="Huang, Jenq Wen" sort="Huang, Jenq Wen" uniqKey="Huang J" first="Jenq-Wen" last="Huang">Jenq-Wen Huang</name>
<name sortKey="Kan, Wei Chih" sort="Kan, Wei Chih" uniqKey="Kan W" first="Wei-Chih" last="Kan">Wei-Chih Kan</name>
<name sortKey="Tsai, Hung Bin" sort="Tsai, Hung Bin" uniqKey="Tsai H" first="Hung-Bin" last="Tsai">Hung-Bin Tsai</name>
<name sortKey="Wu, Kwan Dun" sort="Wu, Kwan Dun" uniqKey="Wu K" first="Kwan-Dun" last="Wu">Kwan-Dun Wu</name>
<name sortKey="Wu, Vin Cent" sort="Wu, Vin Cent" uniqKey="Wu V" first="Vin-Cent" last="Wu">Vin-Cent Wu</name>
<name sortKey="Yang, Ya Fei" sort="Yang, Ya Fei" uniqKey="Yang Y" first="Ya-Fei" last="Yang">Ya-Fei Yang</name>
</country>
</tree>
</affiliations>
</record>

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