Acute kidney injury caused by ammonium acid urate crystals in diabetic ketoacidosis at the onset of type 1 diabetes mellitus

Summary Ammonium acid urate (AAU) crystals are rare in industrialized countries. Furthermore, the number of children with diabetic ketoacidosis (DKA) who develop severe acute kidney injury (AKI) after hospitalization is small. We encountered two patients with AKI caused by AAU crystals during the re...

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Bibliographic Details
Published in:Endocrinology, diabetes & metabolism case reports diabetes & metabolism case reports, 2021-02, Vol.2021 (1), p.1-4
Main Authors: Shimazaki, Shunsuke, Kazukawa, Itsuro, Mori, Kyoko, Kihara, Makiko, Minagawa, Masanori
Format: Article
Language:English
Subjects:
Asian - Japanese
Diabetes
Diuretics
Emergency
Female
Japan
Kidney
Male
Mineral
Nephrology
Paediatric
Paediatric Endocrinology
Paediatrics
Unique/Unexpected Symptoms or Presentations of a Disease
Urology
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Summary:Summary Ammonium acid urate (AAU) crystals are rare in industrialized countries. Furthermore, the number of children with diabetic ketoacidosis (DKA) who develop severe acute kidney injury (AKI) after hospitalization is small. We encountered two patients with AKI caused by AAU crystals during the recovery phase of DKA upon admission. They were diagnosed with severe DKA and hyperuricemia. Their urine volume decreased and AKI developed several days after hospitalization; however, acidosis improved in both patients. Urine sediment analysis revealed AAU crystals. They were treated with urine alkalization and diuretics. Excretion of ammonia in the urine and urine pH levels increased after treatment of DKA, which resulted in the formation of AAU crystals. In patients with severe DKA, the urine and urine sediment should be carefully examined as AAU can form in the recovery phase of DKA. Learning points: Ammonium acid urate crystals could be formed in the recovery phase of diabetic ketoacidosis. Diabetic ketoacidosis patients may develop acute kidney injury caused by ammonium acid urate crystals. Urine and urine sediment should be carefully checked in patients with severe DKA who present with hyperuricemia and volume depletion.
ISSN:2052-0573
2052-0573
DOI:10.1530/EDM-20-0143