Hyperuricaemia

Introduction

whilst low serum urate levels are associated with lower muscle mass, chronic illness and thus is associated with higher morbidity¹⁾, high uric acid (urate) levels (hyperuricaemia) is associated with gout and may also be caused by oncologic conditions

the major cause of the rising prevalence in Western societies is perhaps the increasing intake of fructose
in general hyperuricaemia is caused by either or combined:
- decreased renal excretion
- increased uric acid production
  - increased fructose intake - this generates uric acid and may reduce renal excretion
  - acute tumour lysis syndrome
  - etc
- high purine intake
- GIT microbiota affects on GIT uric acid and purine metabolism as well as uric acid absorption

gout
hyperparathyroidism
psoriasis
sarcoid
renal failure of any cause + diuretics
- elevated serum uric acid levels are associated with the onset of chronic kidney disease [OR = 2.35 (1.59–3.46)] ²⁾
associations but causal link as yet unproven:
- atrial fibrillation
- HT
  - for every 1 mg/dl increase in serum UA, the relative risk of HTN increased 1.13 times ³⁾
- diabetes mellitus
  - asymptomatic hyperuricemia is an independent risk factor for T2DM and insulin resistance [HR = 1.87 (1.33–2.62) and 1.36 (1.23–1.51) ⁴⁾
- C-AMI
  - patients with acute myocardial infarction showed that patients with hyperuricemia are more likely to have major adverse cardiac events [RR = 3.44 (2.33–5.08)] and in-hospital mortality [RR = 2.10 (1.03–4.26)] ⁵⁾

serious and if recognised early, results in significant reduction in morbidity
pathogenesis: increased production, decreased excretion
major source is cell breakdown
major excretory PW is renal
with increased uric acid in kidneys ⇒ crystals in distal tubules ⇒ intrarenal obstruction ⇒ ARF
chronically elevated levels: renal colic, obstructive uropathy, CRF

¹⁾

²⁾ , ³⁾ , ⁴⁾ , ⁵⁾