Experiencia del Hospital Universitario de Canarias con pacientes tratados con plasmaféresis / Patients treated with plasmapheresis: a case review from University Hospital of the Canary Islands

Introducción: La plasmaféresis (PF) es una técnica de aféresis terapéutica utilizada en el tratamiento de diversas enfermedades renales y sistémicas con distintos grados de eficacia clínica demostrada. Objetivo: Analizar los resultados globales de la indicación de PF en el Hospital Universitario de Canarias, enfocados a resultados de su efectividad y seguridad en diversos grupos de enfermedades. Material y métodos: Se trata de un análisis descriptivo retrospectivo de una serie de casos que analiza los resultados de la indicación de PF desde el uno de enero de 2006 hasta el 31 de diciembre de 2009 en nuestro centro. Se revisaron las historias clínicas y se recogieron datos demográficas (sexo y edad), parámetros bioquímicos, enfermedad de base, volumen y tipo de reposición utilizado en la sesión de PF (albúmina humana al 5% y/o plasma fresco congelado), complicaciones asociadas con la técnica, días transcurridos desde la sospecha clínica diagnóstica hasta el inicio de la técnica de aféresis, número de sesiones de PF recibidas, mortalidad del paciente, grado de afectación renal y evolución de la función renal. Resultados: Estudiamos a 51 pacientes, de 50 ± 18 años, el 60% eran hombres, 331 sesiones de PF. Las enfermedades tratadas se agruparon como: 11 vasculitis, 15 inmunoactivaciones del trasplante renal, cinco síndromes hemolítico urémicos, siete casos de púrpura trombótica trombocitopénica o idiopática, dos inmunizaciones Rh fetal, dos enfermedades hematológicas y cuatro casos de enfermedades neurológicas, entre otras. La mortalidad global fue del 19,6 % (n = 10); en seis de los casos, secundaria a shock séptico y en el resto como resultado de la evolución de la enfermedad de base y uno por shock hemorrágico en el área de la biopsia renal. No hubo fallecimientos en el grupo de inmunoactivación del trasplante. En el grupo de vasculitis se produjeron tres fallecimientos (dos de ellos secundarios a un shock séptico). Nueve de los 10 pacientes que fallecieron lo hicieron dentro de los tres primeros meses tras el diagnóstico. De las 26 biopsias renales realizadas, las indicaciones más frecuentes fueron: vasculitis (23%), rechazos humorales (42%), rechazo humoral más toxicidad por anticalcineurínicos (12%) y síndrome hemolítico-urémico (8%), entre otros. Veinticuatro pacientes precisaron hemodiálisis al inicio del cuadro clínico, nueve de los 11 pacientes con vasculitis, cuatro de los cinco pacientes con síndrome hemolítico-urémico y cinco de los 15 pacientes con inmunoactivación del trasplante. Al final de la evolución, 14 de ellos permanecieron en programa de hemodiálisis. Concretamente, cinco de 11 pacientes con vasculitis, dos de 15 pacientes sometidos a trasplante y tres de cinco pacientes con síndrome hemolítico-urémico. De forma significativa, los pacientes que evolucionaron hacia enfermedad renal terminal en el grupo de las vasculitis eran de mayor edad y tenían una mayor creatinina en el comienzo de la enfermedad. En los pacientes sometidos a trasplante en quienes se monitorizaron anticuerpos anti-HLA de clases I o II medidos por luminex pre y post-PF se objetivó una media de descenso del título de anticuerpos en todos excepto en un caso; el descenso medio fue del 51 al 31%. En general, la técnica de PF transcurrió prácticamente libre de complicaciones. Se constataron cinco reacciones al plasma fresco (3%) de carácter leve-moderado (hormigueo peribucal y reacciones urticariformes) que requirieron premedicación con esteroides y no supusieron la interrupción del tratamiento. Conclusión: Teniendo en cuenta la gran variedad de enfermedades que pueden beneficiarse de la PF y el carácter esporádico de algunas de ellas, la publicación de la experiencia con esta modalidad terapéutica cobra gran importancia, ya que si incrementamos la descripción de series de casos por centros, podemos ayudar a ampliar el nivel de evidencia en términos de supervivencia y función renal en múltiples patologías infrecuentes. Nuestro estudio aporta una información útil y valiosa para la práctica clínica habitual y, sin duda, nos hace reflexionar sobre estrategias futuras que optimicen el pronóstico en nuestros enfermos (AU)

Introduction: Plasmapheresis (PP) is a therapeutic apheresis technique used in the treatment of various renal and systemic diseases with varying degrees of proven clinical efficacy. Objective: To review our experience with PP at the Hospital Universitario de Canarias, focused on effectiveness and safety results in different disease groups. Material and methods: A retrospective-descriptive study of patients treated with PP from 01/01/2006 to 31/12/2009 at the hospital. We analysed medical histories and demographic data (sex, age), biochemical parameters, underlying disease, volume and type of replacement used in the PP sessions (5% human albumin and/or fresh frozen plasma), complications with the technique, delay in starting PP treatment after suspected clinical diagnosis, number of PP sessions received, patient mortality, degree of renal impairment and evolution of renal function. Results: There were 51 patients studied, aged 50±18 years, of whom 60% were male; 331 PP sessions were performed. The diseases treated were grouped as: 11 vasculitis, 15 transplant immune activation, 5 haemolytic-uraemic syndrome (HUS), 7 idiopathic or thrombotic thrombocytopaenic purpura, 2 foetal Rh immunisations, 2 haematological diseases, 4 neurological diseases, among others. Overall mortality was 19.6% (n=10): 6 cases secondary to septic shock and the rest as a result of the evolution of the underlying disease, with 1 due to haemorrhagic shock in the renal biopsy area. There were no deaths in the transplant immune activation group. In the vasculitis group, there were 3 deaths (2 secondary to septic shock). Of the 10 patients who died, 9 did so within the first three months after diagnosis. Of the 26 renal biopsies performed, the most frequent indications were: vasculitis (23%), humoral rejection (42%), humoral rejection with calcineurin-inhibitor toxicity (12%) and HUS (8%), among others. Haemodialysis (HD) was required by 24 patients at the start of clinical symptoms: 9 of the 11 patients with vasculitis, 4 of the 5 patients with HUS and 5 of the 15 patients with transplant immune activation. At the end of evolution, 14 of them remained on the HD programme: 5 of the 11 patients with vasculitis, 2 of the 15 transplant patients and 3 of the 5 HUS patients. Significantly, patients who developed end kiney disease (EKD) in the vasculitis group were older and had higher creatinine at the onset of the disease. The transplant patients were monitored for anti-HLA class I or II before and after PP; there was a mean decrease of antibody titres in all but one patient; with an average decrease of 51% to 31%. In general, the PP technique was virtually free of complications. There were only 5 (3%) mild-moderate reactions to fresh plasma (perioral tingling and urticarial reactions) requiring pre-medication with steroids, but which did not lead to discontinuation of the treatment. Conclusion: Taking into account the wide variety of diseases that can benefit from PP and the nature of some of them, publishing our experience with this therapeutic method is of great importance. By increasing the description of case series by centre, we can add survival and renal function evidence in many uncommon diseases. Our study provides useful information for clinical practice and has also led us to reflect on future strategies to optimise outcomes in our patients (AU)

Tratamiento de inducción combinando inmunoglobulinas, plasmaféresis y rituximaben pacientes hipersensibilizados que reciben trasplante renal de cadáver / Induction treatment by combining immunoglobulins, plasmapheresis and rituximab in hypersensitive patients receiving cadaveric renal allograft

En el Hospital Universitario de Canarias pusimos en marcha, en mayo de 2008, un protocolo de tratamiento de inducción para pacientes hipersensibilizados que reciben injerto renal de cadáver utilizando inmunoglobulinas intravenosas, plasmaféresis y rituximab más una inmunosupresión triple con prednisona, tacrolimus y micofenolatomofetil. Presentamos los resultados de 4 pacientes. Todo sellos presentaban una tasa de anticuerpos anti-HLA (PARA por CDC) superior al 75%, llevaban en lista de espera de 4a 17 años, el tiempo de seguimiento posterior al trasplante fue de 10-14 meses y la supervivencia de paciente y del injerto en este período fue del 100%. Sólo un paciente sufrió un rechazo agudo mediado por anticuerpos y otro uno celular, en ambos casos reversibles con el tratamiento. En la evolución no se objetivó aparición de novo de anticuerpos donante-específicos. Todos los pacientes habían reducido significativamente el número de células CD19+ después de la infusión de rituximab. No se han detectado síntomas neurológicos indicativos de leucoencefalopatía multifocal progresiva ni infecciones virales graves después del trasplante y tampoco se han observado efectos secundarios inmediatos tras la administración de la medicación. En resumen, el tratamiento de inducción combinado con inmunoglobulinas, plasmaféresis y rituximab en pacientes (..) (AU)

In our Universitary Hospital of Canarias we iniciated in May2008 a induction therapy protocol for sensitized patients receiving cadaveric renal graft using intravenous immunoglobulins, plasmapheresis and rituximab plusimmuno suppression with prednisone, tacrolimus and mycophenolate mofetil. We present the results of four patients. Everyone had anti-HLA antibodies rate (PRA by CDC) more than 75%, were on a waiting list during 4 to 17 years and follow-up time was 10-14 months after transplantation. Patient and graft survival in this period was 100%. Only one patient suffered a humoral acute rejection and another one cellular rejection, in both cases reversible with treatment. During the first year, no evidence of de novo donor-specific antibodies was detected. All patients had significantly reduced the CD19+ cells percentage after infusion of rituximab. Neurological symptoms suggestive of progressive multifocal leukoencephalopathy or serious viral infections after transplantation have not been observed. Additionally, no immediate side effects were observed after administration of medication. In summary, induction therapy by combining immunoglobulin, plasmapheresis and rituximab in hypersensitive patients allows the realization of deceased kidney transplantation with good results in the short and medium-term without serious side effects. It remains to know whether this success will continue in the long term (AU)

Antibiotic resistance patterns in gram-negative and gram-positive bacteria causing septicemia in newborns in León, Nicaragua: correlation with environmental samples.

The aim of this study was to identify the bacteria causing neonatal septicemia in a neonatal intensive care unit (NICU) in León, Nicaragua and its relation with bacteria isolated from the environment at the NICU. Our data showed that 74% (34/46) of the bacteria related to newborns with septicemia were Gram-negative and highly resistant to beta-lactams (>85%) and aminoglycosides (80%), leading to treatment failure in 10 neonates with fatal outcome. Although, the prevalence of Gram-positive bacteria (26%) was lower than Gram-negative bacteria, Staphylococcus epidermidis was related to the death of three newborns. No clonal similarity was found among Enterobacter cloacae , Escherichia coli and Serratia liquefaciens isolated from the neonates with septicemia and the NICU environment. However, in order to improve the outcome for neonates with septicemia, infection control practices and appropriate empirical therapy should be considered to reduce the high prevalence of extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria isolated from neonates with septicemia (80%) and from the NICU environment (34%).

[Induction treatment by combining immunoglobulins, plasmapheresis and rituximab in hypersensitive patients receiving cadaveric renal allograft]. / Tratamiento de inducción combinando inmunoglobulinas, plasmaféresis y rituximab en pacientes hipersensibilizados que reciben trasplante renal de cadáver.

In our Universitary Hospital of Canarias we iniciated in May 2008 a induction therapy protocol for sensitized patients receiving cadaveric renal graft using intravenous immunoglobulins, plasmapheresis and rituximab plus immunosuppression with prednisone, tacrolimus and mycophenolate mofetil. We present the results of four patients. Everyone had anti-HLA antibodies rate (PRA by CDC) more than 75%, were on a waiting list during 4 to 17 years and follow-up time was 10-14 months after transplantation. Patient and graft survival in this period was 100%. Only one patient suffered a humoral acute rejection and another one cellular rejection, in both cases reversible with treatment. During the first year, no evidence of de novo donor-specific antibodies was detected. All patients had significantly reduced the CD19+ cells percentage after infusion of rituximab. Neurological symptoms suggestive of progressive multifocal leukoencephalopathy or serious viral infections after transplantation have not been observed. Additionally, no immediate side effects were observed after administration of medication. In summary, induction therapy by combining immunoglobulin, plasmapheresis and rituximab in hypersensitive patients allows the realization of deceased kidney transplantation with good results in the short and medium-term without serious side effects. It remains to know whether this success will continue in the long term.

Efecto de la administración crónica de estrógenos en varones transexuales sobre el metabolismo mineral óseo. Influencia del polimorfismo del receptor de la vitamina D / Effect of chronic administration of estrogens on bone mineral metabolism in transsexual males . Influence of Vitamin D receptor polymorphism

Fundamento. No se conoce cuál es el efecto que produce la administración crónica de estrógenos en el metabolismo mineral óseo del varón. Por otra parte, en algunos estudios se ha informado que un determinado polimorfismo del receptor de la vitamina D podría condicionar una mayor densidad mineral ósea. Estos estudios a menudo han mostrado resultados contradictorios y la mayor parte de ellos se han efectuado en mujeres. Por todo ello hemos realizado este trabajo en un grupo de varones transexuales que habían recibido estrógenos durante un mínimo de tres años, con el fin de analizar si un determinado polimorfismo del receptor de la vitamina D condiciona en ellos diferencias en el metabolismo mineral óseo. Método. Estudio transversal de casos y controles. Hemos estudiado marcadores bioquímicos de remodelado óseo, la densidad mineral ósea, así como varias hormonas sexuales y calciotropas. Resultados. Comparados con los controles, los transexuales mostraron menores valores de testosterona libre en sangre y mayores valores de estradiol y de densidad mineral ósea, tanto en la columna lumbar como en la cadera. La bioquímica general, los marcadores bioquímicos de remodelado óseo y las hormonas calciotropas no mostraron diferencias estadísticamente significativas entre ambos grupos. El polimorfismo del receptor de la vitamina D no condicionó ninguna diferencia en estas variables, ni en los transexuales ni en los controles. Conclusiones. No hemos encontrado asociación alguna entre el fenotipo transexual y la distribución del polimorfismo del receptor de la vitamina D. La administración crónica de estrógenos en el varón produce un aumento en los niveles de estradiol sérico, y un incremento en la densidad mineral ósea tanto en la columna lumbar como en la cadera, que no guarda relación con la presencia de un determinado polimorfismo del receptor de la Vitamina D, a pesar de existir una marcada reducción en la concentración de testosterona libre (AU)

[Obstetric decisions concerning adolescents vs. adults]. / La resolución obstétrica de las adolescentes en comparación con la de las adultas.

Information relative to the frequency of vaginal delivery and cesarean section in adolescent population is limited and contradictory. Some publications refer that cesarean section is practiced more frequently in adolescents than in adults, because teenagers have a biological immaturity and a less medical control during pregnancy; but others show that frequency of cesarean section and vaginal delivery is very similar in adolescents as in adults. The reason of this contradiction is the fact that all studies compare general populations, with or without sistemic pathologies, and with or without obstetric antecedents. Therefore, the authors of this paper consider that if they compare adolescent and adult populations in their first pregnancy and without sistemic pathologies, the frequency of cesarean section and vaginal delivery should be the same in the two groups of women. To confirm their hypothesis, the authors collected original data from 121 adolescent women in their first pregnancy, seventeen years old or younger, without sistemic pathology, attended in the Instituto Nacional de Perinatología, and they compared them with original data collected from 121 adult women also in their first pregnancy, between 20 to 27 years old, without sistemic pathology, attended in the same institution and during the same period. The authors concluded that there were not statistical differences between the two groups in relation to the number of prenatal care visits; the weeks of pregnancy at the time of delivery; the indications of the different obstetric procedures to resolve the delivery; and in the perinatal mortality. Nevertheless, there were differences with high statistical significance between the number of vaginal deliveries and the number of cesarean sections; in fact, the cesarean section was performed more frequently in adult women. The authors considered that in the population of adolescents they studied, the age by itself was not a risk factor; furthermore, it is necessary to perform other studies to confirm and to explain why the cesarean section was performed more frequently in the adult population.

[Norplant: a 3-year experience of the National Institute of Perinatology in Mexico]. / Norplant: experiencia de tres años en el Instituto Nacional de Perinatología.

We present the experience from Instituto Nacional de Perinatología (INPer) with the use of subdermal contraceptive implants Norplant from 1995 to 1997. The purpose was to Know the sociodemographic characteristics and evaluate contraceptive efficacy, adverse effects and tolerance on the users of Norplant. We carried out a prospective, observational trial in the Family Planning Clinic, during the period january 1o, 1995 through december 31, 1997. Women with desire of long term hormonal contraception, and without contraindications for the use of progestins were eligible for the study. The follow up consisted in visits every 6 months, and in some cases we obtain the information by telephonic interviews. One hundred an two women were included in the study; the median age of the subjects was 21.6 years, the median number of pregnancies were 2.0. In 53% of the subjects an obstetric risk factor was present such as adolescence (25.5%), social (8.8%), and others. Seventy-four women were followed up, and accumulated 1,064 months of observation. (Average 14.4 months). Menstrual irregulaties (83%), and headache (30%) were the most frequent adverse effects. The continuity rate was 81%, and during the study no pregnancy was observed. The principal causes for the extraction of the implants were menstrual irregulaties and headache. The contraceptive subdermal implants Norplant, constitutes and excellent choice because of its high efficacy, safety and good tolerance.

[Genetic polymorphism of vitamin D receptor and osteoporosis]. / Polimorfismo genético del receptor de la vitamina D y osteoporosis.

BACKGROUND: Genetic factors condition an important part of bone mass. The role of vitamin D receptor polymorphism (VDR) as genetic marker of osteoporosis is a matter of discussion. We have studied the possible influence of VDR on bone remodelling, calciotropic hormones, on the presence of osteoporosis and osteoporotic bone fractures. PATIENTS, CONTROL POPULATION AND METHODS: A case-control study. We have studied a total of 127 postmenopausal Canarian women from Canary Islands, Spain; 66 healthy controls and 61 with the diagnosis of osteoporosis, which was made by clinical, radiological and densitometric criteria. 17 osteoporotic women have had a fracture: Colles, hip or vertebral (spinal deformity index) fracture. VDR were determined by PCR directed to demonstrate the presence (b) or absence (B) of a restriction target for Bsml in intron 7. We analyzed some biochemical markers of bone remodelling: serum levels of alkaline phosphatase, tartrate resistant acid phosphatase and urine ratios of calcium/creatinine and hydroxyproline/creatinine. We also determined calciotropic hormones: parathyroid hormone and calcitonin. Bone mass was measured by DEXA and TC. RESULTS: There were no significant differences in either biochemical bone remodelling markers or in bone mass between the three genotypes: bb, Bb and BB, either in controls or in osteoporotic women with the exception of alkaline phosphatase which had a significative increase compared to control in women with unfavorable alleles distribution (bB and BB). Distribution of genotypes was similar between controls and osteoporotic women, with or without fractures. CONCLUSIONS: In Canarian women, VDR genotype is not associated with changes in biochemical markers of bone remodelling or in bone mass or with the presence of osteoporosis or osteoporotic fractures.

[Manual intrauterine aspiration in the treatment of incomplete abortion]. / Aspiración manual endouterina para el tratamiento del aborto incompleto.

Manual vacuum aspiration (MVA) is a method proposed for uterine evacuation in cases of incomplete abortion, using a syringe of plastic material to produce negative pressure. With this technique, we treated 122 cases of different types of abortion at The Instituto Nacional de Perinatología, and results obtained were compared with those of 126 women treated with standard dilation and curettage (D&C). The sociodemographic characteristics of the two groups were similar. Molar pregnancy and blind ova were more frequent in cases treated with MVA. Types of anesthesia used were similar in both groups with the exception of 10 cases of MVA, that received paracervical block. Four surgical complications occurred, one of hemorrhage in each group and two cases of incomplete evacuation in the MVA group. Histopathological examinations using morphometric techniques showed similar proportions, of fetal parts, villi, decidua, myometrial cells and blood clots for both groups. It was concluded that MVA is as effective and safe as D&C, it is easy to perform, and is not associated with important complications. It can be used as an advantageous option for the evacuation of molar pregnancy.

[Nosocomial infection during puerperium]. / Infección nosocomial durante el puerperio.

Material and methods used to assess the epidemiology of puerperal infection (PI) in the National Institute of Perinatology (Mexico) between 1984 and 1990, are described. We observed that the general rate of PI ranged between 1.6 and 3.1; post-cesarean section posed a higher risk of infection than vaginal partum. Endometritis, associated with cesarean section, was the most frequent form of PI and gram positive flora was the most frequently found etiological agent. In general terms, we found that the rate of PI remained constant through the years of study, even when there was a significant increase in the practice of cesarean operations. Finally, we emphasize the need for the standardization of clinical norms used to assess the epidemiology of infection events. Standard norms will allow health-service institutions to compare results, observe tendencies, predict changes and take preventive actions.

[A study using nondecalcified bone biopsy of the incidence and presentation forms of renal osteodystrophy]. / Estudio con biopsia ósea sin descalcificar de la incidencia y formas de presentación de la osteodistrofia renal.

BACKGROUND: Renal osteodystrophy (ROD) is a common complication of chronic renal failure. Fibrous osteitis and, to a lesser extent, osteomalacia are the predominant lesions. The aim of the present study was to evaluate the prevalence of the different forms of ROD. METHODS: Nondecalcified bone biopsies were evaluated in 100 patients with end-stage renal disease (57 in pre-dialysis and 43 on hemodialysis) in whom biochemical (calcium, phosphorus, alkaline phosphatase, parathyroid hormone) and histomorphometric studies were carried out. Bone biopsies were classified in four histological groups: mild, fibrous osteitis (FO), osteomalacia (OM) and mixed type (FO + OM). RESULTS: 96% of patients had histological findings of ROD with the following distribution: 41% mild; 30% FO; 14% OM; and 11% mixed. The most advanced types of ROD were seen in interstitial renal diseases. Pre-dialysis OM was associated with metabolic acidosis, a low phosphocalcic product and relative hypophosphoremia. Chronic aluminium poisoning was uncommon (7%) and was basically associated with OM. No instance of aluminium poisoning with osteodystrophy and bone fractures was seen. CONCLUSIONS: The most severe histological forms of OM were found in hemodialysis patients with persistent hypophosphoremia and associated with osteosclerosis.

[Contraceptives in high risk reproduction: a health goal still far away. Editorial]. / La anticoncepcion en el alto riesgo reproductivo, una meta de salud todavia lejana.

PIP: High-risk in reproduction is the major health problem in the developing world, responsible for the high incidence of morbidity and mortality rates caused mostly by high fertility rates and the frequency of complications in pregnancy. Therefore, preventing high-risk pregnancies should become the principal objective of all maternal and child health programs worldwide. Unfortunately, both women and physicians continue ignoring symptoms during pregnancy that should be diagnosed as high-risk. A major constraint remains the lack of family planning (FP) services; only 39% (1,500 million) of populations in developing countries as against 65% (800 million) of those in developed countries have access to FP. Added to this problem are people's rejection of FP because of religious, psychological or social pressures, without any information on the dangers of having high-risk pregnancies. The responsibility should be placed on institutions and health practitioners that suspect women who are in high-risk categories and these women should be informed about the risks of future pregnancies.^ieng

[Recovery of kidney function in a female patient with severe lupus nephropathy]. / Recuperación de la función renal en una paciente con nefropatía lúpica severa.

The evolution of Lupus Nephritis to end-stage chronic renal failure is a frequent event. We report the case of a 28 years old patient with diffuse proliferative lupus nephritis with crescents formation and rapid decline of renal function without response to steroids, immunosuppressors and plasmapheresis. After 10 weeks of continued hemodialysis, during which the patient received 30 mg of prednisone in alternate days, renal function recovered spontaneously, and after 1 year of follow-up plasma creatinine is maintained in 2.5 mg/dl.

Bone changes in alcoholic liver cirrhosis. A histomorphometrical analysis of 52 cases.

Bone biopsies of 52 histologically confirmed alcoholic cirrhotic patients and 15 age- and sex-matched controls have been histomorphometrically analyzed determining trabecular bone volume (TBV), mineralized bone volume (MBV), and osteoid volume (OV). We also determined serum PTH, 25-OH-D3, calcitonin, FSH, LH, estradiol, testosterone, T3 and T4, urine cortisol, routine liver function tests, serum and urinary calcium, phosphorus, and magnesium. We found a high prevalence of osteoporosis: TBV was significantly lower in cirrhotic patients (T = 7.23, P less than 0.001), 41 of them being in the range of osteoporosis; none of them had osteomalacia. Levels of all the above-mentioned hormones and electrolytes were almost normal, and no correlation was found between them and liver function tests, as occurred with the bone parameters.

[Neonatal oliguria associated with hyperuricemia]. / Oliguria neonatal asociada a hiperuricemia.

Acute renal failure syndrome in the newborn has many etiologic factors. Hyperuricemia as unique etiology of this syndrome has been seldom cited in literature, although is a well know factor operating together with others. From nine newborns with oliguria, hyperuricemia vas a contributing factor in appearance of the syndrome in seven. In the other two cases hyperuricemia was the sole possible etiologic factor in development of oliguria which was classified as functional. Hyperuricemia alone may be the unique etiologic factor in functional oliguria of the newborn being further investigations needed to understand its precise mechanism.