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  • 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
    • high purine intake
    • GIT microbiota affects on GIT uric acid and purine metabolism as well as uric acid absorption

oncologic settings:

associated non-malignant conditions

  • 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:
      • for every 1 mg/dl increase in serum UA, the relative risk of HTN increased 1.13 times 3)
      • 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)
      • 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

May cause 3 types of renal disease:

  • acute hyperuricaemic nephropathy
  • uric acid nephrolithiasis
  • gouty nephropathy

symptoms & signs in the oncologic patient:

  • +/- asymptomatic
  • underlying malignancy
  • with symptoms of tumour lysis syndrome
  • acute oliguria following chemotherapy
  • renal colic


  • serum uric acid
  • U + E

management in the oncologic patient:

  • pretreat hyperuricaemia- prior to chemo or XRT
  • hydration
  • consider Na Bicarbonate (alkalinise urine), diuretics
  • mannitol
  • peritoneal dialysis/haemodialysis

management in the patient with gout

hyperuricaemia.txt · Last modified: 2023/07/20 13:11 by gary1

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