title: Renal hypouricemia due to enhanced tubular secretion of urate associated with urolithiasis: successful treatment of urolithiasis by alkalization of urine K+, Na(+)-citrate.
abstract: We encountered a case of hypouricemia with increases both in urate clearance (Cur) and in the ratio of Cur to creatinine clearance (Cur/Ccr), the normal daily urinary excretion of urate, and urolithiasis. Pyrazinamide markedly decreased Cur and Cur/Ccr, and both probenecid and benzbromarone markedly increased Cur and Cur/Ccr, however, benzbromarone did not increase either Cur or Cur/Ccr under pretreatment with pyrazinamide in the patient. Thus, the diagnosis was made of renal hypouricemia due to enhanced tubular secretion of urate. The urinary pH of the patient tended to be acidic. Three months after the start of alkalization of the patient's urine by K+, Na(+)-citrate, both urolithiasis and the symptoms related to urolithiasis disappeared. These results suggest that renal hypouricemia due to enhanced tubular secretion of urate can result in urolithiasis and the alkalization of urine may be an effective treatment for uric acid stones.
authors.affiliation: First Department of Internal Medicine, Tottori University, Yonago, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Hisatome
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: H
authors.initials: H
authors.lastname: Kotake
authors.forename: H
authors.initials: H
authors.lastname: Kosaka
authors.forename: N
authors.initials: N
authors.lastname: Hirata
authors.forename: Y
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: A
authors.initials: A
authors.lastname: Yoshida
authors.forename: C
authors.initials: C
authors.lastname: Shigemasa
authors.forename: H
authors.initials: H
authors.lastname: Mashiba
authors.forename: R
authors.initials: R
authors.lastname: Sato
mesh_terms: D001553:Benzbromarone / Q000494:pharmacology; D002951:Citrates / Q000378:metabolism / Q000627:therapeutic use*; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007674:Kidney Diseases / Q000097:blood* / Q000209:etiology* / Q000503:physiopathology; D007684:Kidney Tubules / Q000378:metabolism*; D008875:Middle Aged; D011339:Probenecid / Q000494:pharmacology; D011718:Pyrazinamide / Q000494:pharmacology; D014527:Uric Acid / Q000097:blood* / Q000378:metabolism / Q000652:urine*; D014545:Urinary Calculi / Q000150:complications / Q000188:drug therapy / Q000652:urine
chemical_list: D002951:Citrates; D014527:Uric Acid; D011718:Pyrazinamide; D001553:Benzbromarone; D003404:Creatinine; D011339:Probenecid