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April 1963

Acute Uric Acid NephropathyTreatment with Mannitol Diuresis and Peritoneal Dialysis

Arch Intern Med. 1963;111(4):452-459. doi:10.1001/archinte.1963.03620280052008

Hyperuricemia in patients with lymphoma and leukemia occurs spontaneously and as a complication of cytotoxic therapy. Increased urinary urate excretion may exceed the ability of the renal tubules to keep urates in solution: Acute renal failure secondary to urate crystallization in the kidneys and genitourinary tract is a sequel.1-3

In the past, if urine flow could not be maintained in the hyperuricemic patient by water loading and alkali therapy, procedures such as ureteral catheterization, nephrostomy, or hemodialysis were required to prevent death from acute renal failure.4 In two patients with severe hyperuricemia, azotemia, and oliguria unresponsive to water loading and alkali therapy, we have been able to avoid hemodialysis. The favorable result in their cases has prompted this report. Diuresis accompanied by lowering of serum uric acid and blood urea nitrogen levels to normal was secured in these patients by the intravenous infusion of the osmotic diuretic, mannitol.