A case of hepatocellular carcinoma associated with renal hypouricemia

Abstract

A 34 year-old woman (HB carrier) developed diffuse type hepatocellular carcinoma (HCC) (Edmondson Grade III) associated with renal hypouricemia. Laboratory findings revealed elevation of serum AFP (259000ng/ml) and marked hypouricemia (1.3mg/dl). A 24-hour excretion of uric acid was not decreased; renal clearance studies showed high ratio of urate to creatinine clearance, whereas creatinine clearance was normal, indicating that the hypouricemia was due to excessive renal excretion of uric acid. The tumor rapidly progressed to be resistant to a course of therapy and she died of DIC following pneumonia. Serum uric acid remained very low throughout. Several factors that would affect the uric acid level were excluded, and only minimal abnormalities of other tubular functions were detected. The underlying mechanism (s) that led to abnormal renal handling of uric acid was unknown. We would suggest that renal hypouricemia which was thought to be related to tumor metabolism (tumoral hypouricemia), should be considered one of clinical signs of paraneoplastic syndrome in patients with HCC.