Authors :
Presenting Author: Amanda Simon, MD – University of Utah
Amir Arain, MD, MPH – Professor, Neurology, University of Utah; Blake Newman, MD – Assistant Professor, Neurology, University of Utah; Dan Nguyen, MD – Fellow, Neurology, University of Minnesota
Rationale: Acute kidney injury is a well-known complication of generalized tonic-clonic seizures, most commonly due to rhabdomyolysis. Elevated serum uric acid resulting in uric acid nephropathy is frequently overlooked as a cause of acute kidney injury in these patients, with only a few published case reports to date. The treatment of this condition has historically been hemodialysis.
Methods: The patients included in this case series presented to the University of Utah Hospital between 2021 and 2022 for evaluation and treatment.
Results:
In the first case, a 23-year-old male was admitted to the Neurological Critical Care Unit with status epilepticus in the setting of medication non-compliance. His kidney function worsened despite treatment with intravenous fluids. He developed anuria and had a serum uric acid level of 20.7 mg/dL. The patient required biweekly sessions of hemodialysis for over one month before he eventually had full recovery of renal function. In the second case, a 32-year-old male was admitted to the Internal Medicine service with acute kidney injury after experiencing a breakthrough seizure in the setting of infection. He had a serum uric acid level of 20.4 mg/dL. He was treated with rasburicase with subsequent recovery of renal function prior to discharge. In the third case, a 29-year-old male was admitted to the Neurological Critical Care Unit with status epilepticus in the setting of subtherapeutic anti-seizure medication dosing. His renal function deteriorated despite initiation of intravenous fluids. He had a serum uric acid level of 19.5 mg/dL. He required one session of hemodialysis as well as rasburicase due to delayed recognition of the etiology of his acute kidney injury. After administration of rasburicase, he did not require subsequent sessions of hemodialysis and his renal function fully recovered.
Conclusions:
Uric acid nephropathy is a rare complication of generalized tonic-clonic seizures, which is poorly recognized by healthcare providers. It is critical for healthcare providers to counsel patients with generalized tonic-clonic seizures on strict adherence to their anti-seizure medication regimen to hopefully avoid this severe form of acute kidney injury. While the treatment of this condition has traditionally been hemodialysis, we advocate for the early use of rasburicase to avoid the associated morbidity of renal replacement therapies.
Funding:
No funding sources were obtained in support of this abstract.