Anuria secondary to hot weather-induced hyperuricaemia: diagnosis and management

ABSTRACT

There is little information on the management of anuria secondary to severe volume depletion or as a rare manifestation of heat stroke in areas of the world with very hot summers. We present our experience with hot weather-induced hyperuricaemia in Kuwait. Patients and Patients presenting to our urology unit as an emergency during the hot summer months of April to October [average temperature 40-55oC] were suspected of having hot weather-induced anuria secondary to hyperuricemia if they had a history of working in the sun for 6 to 8 hours per day and a progressive decrease in urine output to complete anuria. The diagnosis was confirmed by demonstration of elevated serum creatinine and uric acid, ultrasound findings of normal kidneys, ureters, and bladder [KUB] or mild to moderate hydronephrosis, but no features of chronic renal disease and little or no urine in the bladder. Management consisted of emergency cystoscopy, retrograde pyelogram, ureterorenoscopy [URS], and stents followed by rehydration, oral allopurinol and urinary alkalinization. Twenty-nine patients [27 males and 2 females, mean age, 44.52 8.3 years] satisfied the diagnostic criteria for anuria secondary to hot weather-induced hyperuricaemia. Twentyeight [97%] patients worked outdoors on construction sites. Six patients had small radiopaque calculi on plain KUB X-ray. During cytoscopy and URS, uric acid crystals were encountered in all patients in the ureters and bladder. Recovery of renal function was complete in 23/29 [79.3%] patients, while 4/29 [13.8%] had partial recovery and 2/29 [6.9%] had no renal recovery. Hot weather-induced anuria secondary to hyperuricaemia is a complication of severe dehydration. Effective treatment will result in successful resolution of this rare but reversible cause of acute renal failure in about 80% of cases. Ancillary treatment methods like haemodialysis or the use of PCN can be safely avoided in the majority of the patients. However, rehydration alone may be insufficient treatment in these patients