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. 2005 Jan;45(1):88-95.
doi: 10.1053/j.ajkd.2004.09.031.

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

Vin-Cent Wu  1 , Jenq-Wen Huang, Po-Ren Hsueh, Ya-Fei Yang, Hung-Bin Tsai, Wei-Chih Kan, Hong-Wei Chang, Kwan-Dun Wu, SARS Research Group of National Taiwan University College of Medicine and National Taiwan University Hospital
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Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome

Vin-Cent Wu et al. Am J Kidney Dis. .
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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 micromol/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-alpha (TNF-alpha) were measured in 16 patients.

Results: Sixteen patients (26.7%) had hypouricemia (UA, 1.68 +/- 0.52 mg/dL [100 +/- 31 micromol/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 UA) 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 FE UA 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 FE UA (P < 0.001; r = 0.785) and inversely with serum UA level (P = 0.044; r = -0.509); neither IL-6 nor TNF-alpha 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.

Figures

Fig 1
Serum UA levels in patients with SARS measured in different periods after fever: 1 to 5, 6 to 9, and 10 to 14 days. Sixteen patients were identified as hypouricemic (dotted bar), and 44 patients, normouricemic (black bar). Numbers in parentheses indicate the number of patients with serum UA measurements in that period. *P = 0.001.
Fig 2
The relationship between serum UA level and FEUA in 43 patients with SARS. Dashed lines indicate FEUA of 10% (horizontal) and serum UA level of 2.5 mg/dL (149 μmol/L; vertical). To convert UA in mg/dL to μmol/L, multiply by 59.48.
Fig 3
FEUA of patients who did versus did not need endotracheal intubation. Lines indicate mean values for the 2 groups.
Fig 4
Kaplan-Meier survival estimates of patients with SARS according to hypouricemic and normouricemic groups; P = 0.01 by log-rank test.
Fig 5
Relationships between FEUA and serum IL-6, IL-8, and TNF-α levels in 16 patients with SARS.
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References

    1. Ksiazek T.G., Erdman D., Goldsmith C.S. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953–1966. - PubMed
    1. Peiris J.S., Chu C.M., Cheng V.C. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: A prospective study. Lancet. 2003;361:1767–1772. - PMC - PubMed
    1. Tsai H.B., Huang J.W., Chen K.Y. Acute renal failure and renal replacement therapy in SARS patients. Presented at the Annual Committee on American Society of Nephrology, San Diego, CA, November 12–17. 2003. (abstr)
    1. Wu V.C., Hsueh P.R., Lin W.C. Acute renal failure in SARS patients: More than rhabdomyolysis. 2003. Presented at the 20th Annual Committee on Taiwan Society of Nephrology, Taipei, Taiwan, December 13–14 (abstr) - PMC - PubMed
    1. Vas S.I. Primary and secondary role of viruses in chronic renal failure. Kidney Int Suppl. 1991;35:S2–S4. - PubMed

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