WCN25-1406 ASSOCIATION OF VASOPRESSOR USE DURING RENAL REPLACEMENT THERAPY AND MORTALITY IN ACUTE KIDNEY INJURY

Conclusions: APRT deficiency can manifest at any age.The age of presentation varies from infancy to 8th decade of life.The disease is diagnosed late because it may remain asymptomatic for many years.Moreover, the lack of clinical suspicion, even in patients who have nephrolithiasis, further causes delay in diagnosis.True to its heterogeneous clinical presentation, our patient remained asymptomatic until 45 years of age.There was no personal or family history of urolithiasis.It has been seen that DHA nephropathy may present as an acute disease leading to renal failure in a few days or weeks or, more frequently, develop slowly and cause progressive decline of renal function during a period of several years.Acute renal failure may be triggered by dehydration, which causes urine supersaturation, and precipitation of DHA leading to acute kidney injury which if undiagnosed frequently leads to chronic kidney disease.Our patient who was previously asymptomatic presented with acute kidney injury.We hypothesize that recurrent vomiting lead to dehydration in our patient which caused DHA crystallization leading to kidney dysfunction.Treatment of APRT deficiency relies on allopurinol therapy, which acts by blocking xanthine oxidase.In patients with DHA nephropathy, allopurinol therapy usually allows renal function to stabilize or improve and prevents recurrence after renal transplantation.APRT deficiency should be considered in all cases of urolithiasis in children, recurrent urolithiasis (especially if the stones are radiolucent), and urolithiasis associated with unexplained renal dysfunction.Whenever possible, a thorough stone analysis should be conducted.Crystalluria can be particularly useful, especially when no stone is available for analysis.An APRT activity assay is useful when no stone is available and crystalluria cannot be studied in a patient with crystalline nephropathy, such as in cases of anuria, especially for patients undergoing a kidney transplant.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.