Uric Acid Crystal Nephropathy

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Uric Acid Crystal Nephropathy
(a) The patient with exfoliative dermatitis with severe erythroderma on the upper torso. (b) Skin lesions also affecting lower extremities with nail involvement. (c) Renal ultrasound showing nephrolithiasis in the renal calyx. (d) Urine sediment displaying numerous rounded parallelogram‐shaped crystals, consistent with uric acid crystals.

Uric Acid Crystal Nephropathy secondary to erythodermic psoriasis.

This article presents the case of uric acid crystal nephropathy caused by erythodermic psoriasis. The disease is well described and has a rapid cell turnover, for example, tumour lysis syndrome. Therefore, it is important to recognise the rare complication early with administration of aggressive fluid resuscitation, urine alkalinization and uric acid lowering agents.

The 57-year-old male patient from Thailand presented with diffuse scaling of his skin.

He was diagnosed with long-standing psoriatic arthritis and was currently under treatment with adalimumab, leflunomide, and topical clobetasol. However, he stopped taking the medications two weeks before the presentation. The patient was a gardener by profession and was able to complete daily activities of living without any assistance. Although, during the disease course he suffered with diarrhoea which led to fatigue and diffuse scaling of the skin. He complained of chronic left ankle pain, also. However, he did not have any complaints of oral ulcers.

Physical examination was consistent with diffuse yellow scaling that covered his entire body.

Signs of underlying erythema and tenderness in the absence of mucosal involvement were also present. Doctors advised empiric antibiotics till an infection was ruled out. The patient had no prior history of renal disease. His test results showed high levels of creatinine consistent with acute renal failure. He was referred to the intensive care unit and administered 4 L of normal saline for initial resuscitation. However, the patient’s renal function did not improve despite the aggressive fluid administration. Over the next 48 hours the patient developed anuria, similarly, his creatinine and phosphate levels continued to peak.

Renal ultrasound showed a nonobstructing renal calculi in his left kidney, measuring 5 mm and small echogenic kidneys. The patient was diagnosed with uric acid crystal-induced nephropathy. Treatment included rasburicase, urinary alkalinization, and fluids. Leflunomide, topical isotretinoin, and clobetasol were restarted to treat the psoriasis. His renal function improved dramatically and he was discharged on topical clobetasol, leflunomide and secukinumab.

References

Erythrodermic Psoriasis Causing Uric Acid Crystal Nephropathy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458895/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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