Hypouricemia in individuals admitted to an inpatient hospital-based facility
Hypouricemia in individuals admitted to an inpatient hospital-based facility
复制标题
DOI：
10.1016/s0272-6386(03)00355-x
复制
发表时间：
2003-06-01
影响因子：
13.2
通讯作者：
Elisaf, MS
中科院分区：
文献类型：
--
作者：
Bairaktari, ET;Kakafika, AI;Elisaf, MS
背景资料：在因孤立性或全身性近端肾小管损伤住院的患者中，偶尔报告肾性尿酸盐消耗导致血清尿酸水平降低。关于内科门诊患者低尿酸血症的发病率和病因，最近的研究结果有限。本研究的目的是检查低尿酸血症的患病率在个人承认我们的住院医院为基础的设施，并确定潜在的原因和发病机制，以及低尿酸血症和尿酸尿与其他肾小管缺陷的任何关联。方法：共有7,250名患者在入院时进行了血清尿酸测定。低尿酸血症定义为血清尿酸水平低于2.5 mg/dL（149 mumo/L）。在所有低尿酸血症病例中，进行了详细的临床和实验室检查。结果：90例（1.24%）患者出现低尿酸血症。除1例患者外，所有患者的低尿酸血症均与不适当的尿酸尿有关（尿酸盐排泄分数[FE] > 10%;范围，10.8%至94%）。血尿酸水平与其FE呈负相关（r = -0.73; P < 0.0001）。低尿酸血症最常见的原因是任何原因的阻塞性黄疸（n = 18）、实体瘤或血液肿瘤（n = 17）、糖尿病（n = 12）、影响尿酸盐稳态的药物（n = 10）和颅内疾病（n = 8）。17例低尿酸血症患者表现出一种或多种近端肾小管损伤的其他表现，如糖尿、导致低磷酸盐血症的不适当磷酸盐尿和导致低钾血症的钾尿。结论：不适当的血尿引起的低尿酸血症在内科门诊患者中并不罕见，与基础疾病有关，并可能与近端肾小管功能的其他异常有关。
Background: Decreased serum uric acid levels resulting from renal urate wasting occasionally are reported in hospitalized patients because of isolated or generalized proximal tubular damage. There are limited recent findings with regard to the incidence and cause of hypouricemia in patients admitted to an internal medicine clinic. The aim of this study is to examine the prevalence of hypouricernia In individuals admitted to our inpatient hospital-based facility and identify underlying causes and pathogenetic mechanisms and any association of hypouricemia and uricosuria with other tubular defects. Methods: A total of 7,250 serum urate measurements were available on patients' admission. Hypouricemia Is defined as a serum urate level less than 2.5 mg/dL (149 mumo/L). In all hypouricemic cases, a detailed clinical and laboratory investigation was performed. Results: Hypouricemia was found in 90 patients (1.24%). In all except one patient, hypouricemia was associated with inappropriate uricosuria (urate fractional excretion [FE] > 10%; range, 10.8% to 94%). There was an inverse correlation between serum uric acid level and its FE (r = -0.73; P < 0.0001). The most common causes of hypouricernia were obstructive jaundice of any cause (n = 18), solid or hematologic neoplasias (n = 17), diabetes mellitus (n = 12), drugs affecting urate homeostasis (n = 10), and intracranial diseases (n = 8). Seventeen patients with hypouricemia showed one or more other manifestations of proximal tubular damage, such as glucosuria, inappropriate phosphaturia leading to hypophosphatemia, and kaliuria resulting in hypokalemia. Conclusion: Hypouricemia caused by inappropriate uricosuria is not rare in patients admitted to an internal medicine clinic, is related to underlying diseases, and may be associated with other abnormalities of proximal tubular function.