痛風と核酸代謝
Online ISSN : 2186-6368
Print ISSN : 1344-9796
ISSN-L : 1344-9796
総説
「腎性低尿酸血症診療ガイドライン」(第1版)の策定
中山 昌喜松尾 洋孝太田原 顕荻野 和秀箱田 雅之浜田 紀宏細山田 真山口 聡久留 一郎市田 公美四ノ宮 成祥
著者情報
ジャーナル フリー

2018 年 42 巻 1 号 p. 1-6

詳細
抄録

The world- first clinical practice guideline (CPG) for renal hypouricemia (RHUC) has developed from Japan along MINDS methodology last year. Its first goal is to clarify the criteria for diagnosing RHUC, and another goal is to work towards a consensus on clinical decision-making.

RHUC is caused by a dysfunction of renal urate reabsorption. It does not include congenital purine metabolism abnormalities or secondary hypouricemia, and is relatively common (0.3%) in Japanese populations. Genetic analyses have demonstrated its causes as dysfunctional variants in urate reabsorption transporter URAT1/SLC22A12 and/or GLUT9/SLC2A9 genes, but there should be unknown causative genes. One of the characteristics of RHUC is a low serum uric acid (SUA) level with increased renal excretion of uric acid. CPG proposed its clinical diagnostic guidance for RHUC along clinical algorithm, which enables easy diagnosis with simple tests. RHUC itself is usually asymptomatic, but exercise-induced acute kidney injury (EIAKI, also known as “ALPE”) and urolithiasis are well-known complications. EIAKI cases generally show transient and recurrent acute kidney injury (AKI), and receive common treatment for AKI. For urinary stones, urinary alkalization and citrate compounds are effective therapies and fluid intake is recommended for prevention.

We strongly recommend that individuals with an SUA of ≤ 2.0 mg/dl (120 µmol/l) be considered for differential diagnosis of hypouricemia. Some studies reports that allopurinol, a xanthine oxidoreductase (XOR) inhibiter, was administered as prevention for EIAKI, but due to low evidence, we cannot definitively state that XOR inhibitors are effective. It should be therefore decided in the light of its potential benefits and harms.

We hope that this CPG helps both healthcare providers and patients make clinical decisions, and will also promote the researches on RHUC.

著者関連情報
© 2018 一般社団法人 日本痛風・核酸代謝学会
前の記事 次の記事
feedback
Top