신성 저요산혈증 1례

A case of idiopathic renal hypouricemia

  • 한문희 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 박상욱 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 김덕수 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 심재원 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 심정연 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 정혜림 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 박문수 (성균관대학교 의과대학 강북삼성병원 소아과)
  • Han, Moon Hee (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Sang Uk (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Deok-Soo (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan) ;
  • Shim, Jae Won (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shim, Jung Yeon (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jung, Hye Lym (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Moon Soo (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2007.03.21
  • 발행 : 2007.05.15

초록

신성 저요산혈증은 신장에서 요산의 배설이 증가하는 것으로 무증상이거나 이차적으로 혈뇨, 요로결석, 신부전 등을 일으킬 수 있다. 저자들은 가성저알도스테론혈증으로 진단된 환아의 추적검사에서 추가적으로 신성 저요산혈증을 진단하고 환아 및 가족의 유전자검사를 통해 hURAT1 유전자의 R90H, W258X 이형접합자 변이를 확인하였기에 문헌고찰과 함께 보고하는 바이다.

Idiopathic renal hypouricemia is a disorder characterized by impaired urate handling in the renal tubules. This disease usually produces no symptoms, but hematuria, uric acid nephrolithiasis or acute renal failure may develop. A defect in the SLC22A12 gene, which encodes the human urate transporter, is the known major cause of this disorder. We describe a 10-month-old boy with idiopathic renal hypouricemia. He was diagnosed with transient pseudohypoaldosteronism at admission, but hypouricemia was accidentally found through follow-up study. By gene analysis, his diagnosis was confirmed to idiopathic renal hypouricemia. In addition, we report a mutation in the human urate transporter 1 (hURAT1) gene identified in his family.

키워드

참고문헌

  1. Yamanaka H, Taniguchi A, Kamatani N, Kashiwazaki S. Sjogrens syndrome in one of two sisters with idiopathic renal hypouricemia. Intern Med 1994;33:505-7 https://doi.org/10.2169/internalmedicine.33.505
  2. Cheong HI, Kang JH, Lee JH, Ha IS, Kim S, Komoda F, et al. Mutational analysis of idiopathic renal hypouricemia in Korea. Pediatr Nephrol 2005;20:886-90 https://doi.org/10.1007/s00467-005-1863-3
  3. Wakida N, Tuyen DG, Adachi M, Miyoshi T, Nonoguchi H, Oka T, et al. Mutations in human urate transporter 1 gene in presecretory reabsorption defect type of familial renal hypouricemia. J Clin Endocrinol Metab 2005;90:2169- 74 https://doi.org/10.1210/jc.2004-1111
  4. Ohta T, Sakano T, Igarashi T, Itami N, Ogawa T; ARF Associated with Renal Hypouricemia Research Group. Exercise-induced acute renal failure associated with renal hypouricaemia: results of a questionnaire-based survey in Japan. Nephrol Dial Transplant 2004;19:1447-53 https://doi.org/10.1093/ndt/gfh094
  5. Ito O, Hasegawa Y, Sato K, Mitsui H, Yuda F, Sato H, et al. A case of exercise-induced acute renal failure in a patient with idiopathic renal hypouricemia developed during antihypertensive therapy with losartan and trichlormethiazide. Hypertens Res 2003;25:509-13
  6. Choi SC, Kim YG, Do JH, Kim JA, Lee YK, Lee HH, et al. Patient with renal hypouricemia and exercise induced acute renal failure. Korean J Nephrol 2002;21:312-6
  7. Ichida K, Hosoyamada M, Hisatome I, Enomoto A, Hikita M, Endou H, et al. Clinical and molecular analysis of patients with renal hypouricemia in Japan-influence of URAT1 gene on urinary urate excretion. J Am Soc Nephrol 2004; 15:164-73 https://doi.org/10.1097/01.ASN.0000105320.04395.D0
  8. Mount DB, Kwon CY, Zandi-Nejad K. Renal urate transport. Rheum Dis Clin North Am 2006;32:313-31 https://doi.org/10.1016/j.rdc.2006.02.006
  9. Hirasaki S, Koide N, Fujita K, Ogawa H, Tsuji T. Two cases of renal hypouricemia with nephrolithiasis. Intern Med 1997;36:201-5 https://doi.org/10.2169/internalmedicine.36.201
  10. Lee JH, Choi JH, Park YS, Yoo HW, Jeong JY. A case of idiopathic renal hypouricemia with URAT1 gene mutation who showed persistent orange-colored urine. J Korean Soc Pediatr Nephrol 2006;10:65-71
  11. Tanaka M, Itoh K, Matsushita K, Matsushita K, Wakita N, Adachi M, et al. Two male siblings with hereditary renal hypouricemia and exercise-induced ARF. Am J Kidney Dis 2003;42:1287-92 https://doi.org/10.1053/j.ajkd.2003.08.032
  12. Hosoyamada M, Ichida K, Enomoto A, Hosoya T, Endou H. Function and localization of urate transporter 1 in mouse kidney. J Am Soc Nephrol 2004;15:261-8 https://doi.org/10.1097/01.ASN.0000107560.80107.19
  13. Needham E. Management of acute renal failure. Am Fam Physician 2005;72:1739-46
  14. Sartorato P, Lapeyraque AL, Armanini D, Kuhnle U, Khaldi Y, Salomon R, et al. Different inactivating mutations of the mineralocorticoid receptor in fourteen families affected by type I pseudohypoaldosteronism. J Clin Endocrinol Metab 2003;88:2508-17 https://doi.org/10.1210/jc.2002-021932
  15. Mayan H, Vered I, Mouallem M, Tzadok-Witkon M, Pauzner R, Farfel Z. Pseudohypoaldosteronism type II: marked sensitivity to thiazides, hypercalciuria, normomagnesemia, and low bone mineral density. J Clin Endocrinol Metab 2002;87:3248-54 https://doi.org/10.1210/jc.87.7.3248
  16. Luft FC. Present status of genetic mechanisms in hypertension. Med Clin North Am 2004;88:1-18 https://doi.org/10.1016/S0025-7125(03)00118-4
  17. Tutunculer F, Gunoz H, Bas F, Bundak R, Saka N, Neyzi O. Transient pseudohypoaldosteronism in an infant with urinary tract anomaly. Pediatr Int 2004;46:618-20 https://doi.org/10.1111/j.1442-200x.2004.01937.x
  18. Schoen EJ, Bhatia S, Ray GT, Clapp W, To TT. Transient pseudohypoaldosteronism with hyponatremia-hyperkalemia in infant urinary tract infection. J Urol 2002;167:680-2 https://doi.org/10.1016/S0022-5347(01)69124-9
  19. Melzi ML, Guez S, Sersale G, Terzi F, Secco E, Marra G, et al. Acute pyelonephritis as a cause of hyponatremia/hyperkalemia in young infants with urinary tract malformations. Pediatr Infect Dis J 1995;14:56-9 https://doi.org/10.1097/00006454-199501000-00012