A patient has very high serum uric acid levels and is at imminent risk of developing acute nephropathy. Which of the following might be used to reduce the risk of this serious response by increasing the solubility of uric acid in the urine?
a. Here we asked about reducing the risk of urate nephropathy acutely by increasing uric acid solubility. One key to answering this question correctly is to realize that uric acid becomes more soluble (less likely to precipitate or crystallize) as local pH rises.
b. Recall that normal urine is acidic. By alkalinizing the urine, which is precisely what acetazolamide does, we can reduce the risk of stone formation.
c. Note that acetazolamide is only an adjunct, and in addition to (or instead of) using it, we might also administer sodium bicarbonate, which will alkalinize the urine. Maintaining adequate hydration to help form relatively large volumes of a dilute urine is important.
It is a recombinant version of the enzyme called urate oxidase. The drug is used in tumor lysis syndrome and hyperuricemia related to cancers. The drug catalyses the conversion of uric acid to allantoin which is 10 times more soluble than uric acid thus fasciluting its elimination.