The occurrence of acute renal failure in association with hyperuricemia and hyperuricosuria is well recognized in patients with leukemia and lymphoma. In the January issue of the Archives (137:97-99, 1977), Crittenden and Ackerman reported the development of hyperuricemic acute renal failure in a patient with disseminated carcinoma.
The pathogenesis of this type of renal failure, often referred to as acute uric acid nephropathy, is not known. However, it is known that the concentration of uric acid increases progressively along the tubule as a result of the reabsorption of water and that uric acid is only sparingly soluble at the acidic pH that is often characteristic of luminal fluid within the distal nephron. Thus, several authors1,2 have suggested that these events may facilitate the precipitation of uric acid crystals within the collecting duct system when urinary uric acid excretion is increased. Such crystalline deposits may then decrease renal function by a