Abstract
A l5-year-old Japanese boy developed acute renal failure (ARF) following physical exercise (400-m relay) at school. He developed abdominal pain with nausea and vomiting, which lasted for 3 days from onset, and eyelid swelling was observed 2 days before visiting the hospital.
He was found to have hypertension (154/90mmHg), blood urea nitrogen of 39.9mg/dl and serum creatinine of 5.3mg/dl, but serum uric acid level was normal (4.3mg/dl), and he was non-oliguric (2,000ml/day). Proteinuria and hematuria were negative. Nausea, vomiting and abdominal pain resolved spontaneously. With a conservative therapy, nonoliguric acute renal failure improved. With recovery of renal function, hypouricemia (0.6mg/dl) became evident. Pyrazinamide and benzbromarone test, i. e. Fractional excretion of uric acid (FEua), was markedly increased (37.7%). FEua in pyrazinamide test was slightly decreased. FEua in benzbromarone test was slightly increased. Results showed that the patient had a defective presecretory uric acid reabsorption. His father was also found to be hypouricemic (1.0mg/dl). Uric acid is a strong antioxidant, and therefore patients with renal hypouricemia are prone to develop acute renal failure. lt is proposed that oral supplementation of antioxidants or scavengers, such as vitamin E, vitamin C, allopurinol, prevent the recurrence of ARF.
