hyperuricemia
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Etiology
- tumor lysis syndrome
- chemotherapy-induced
- spontaneous (Burkitt lymphoma)[12]
- overproduction
- primary defect in purine metabolism
- PRPP synthetase overactivity
- HGRPT deficiency
- myeloproliferative disorders
- lymphoproliferative disorders
- disseminated cancer (carcinoma & sarcoma)
- chronic hemolytic anemia
- psoriasis
- infectious mononucleosis
- obesity
- increased dietary intake of purines
- hyperalimentation
- alcoholic beverages & high-fructose corn syrup may increase uric acid production
- beer, spirits, wine, soft drinks
- growth factor treatment: GM-CSF, G-CSF, erythropoietin
- non-adherence to allopurinol
- likely cause in patients previously well-controlled on allopurinol[12]
- primary defect in purine metabolism
- underexcretion
- hereditary, renal tubule-based[4]
- intrinsic renal disease
- pharmaceutical agents
- endocrine disorders
- metabolic disorders
- dietary purines or purine-inducing foods
- contributory, insufficient alone
- red meat, shellfish, high-fructose corn syrup
- sarcoidosis
- Down's syndrome
- berylliosis
- gouty arthritis
Genetics
- more important than diet[11]
Clinical manifestations
Laboratory
Complications
- gout
- nephrolithiasis (including tumor lysis syndrome)
- no convincing association between hyperuricemia & any other health outcome[9]
Management
- do not treat patients for asymptomatic hyperuricemia (see gout)[4]
- hypertension:
- HCTZ may increase serum urate[4]
- losartan (unique among ARBS) has uricosuric effect
- calcium channel blockers also lower serum urate[4]
- allopurinol is associated with less chronic renal failure than febuxostat[10]
- Healthy Eating, DASH diet, & Mediterranean diet associated with lower serum uric acid[11]
- eggs, peanuts, cold cereal, skim milk, cheese, brown bread, margarine, & non-citrus fruit associated with lower serum uric acid[11]
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 831
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 858-61
- ↑ 3.0 3.1 3.2 Prescriber's Letter 10(10):58 2003
- ↑ 4.0 4.1 4.2 4.3 4.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 5.0 5.1 ARUP Consult: Hyperuricemia - Gout The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/hyperuricemia
- ↑ Prescriber's Letter 19(12): 2012 GUIDELINES: 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=281224&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Mandell BF. Clinical manifestations of hyperuricemia and gout. Cleve Clin J Med. 2008 Jul;75 Suppl 5:S5-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18822469
- ↑ Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011 Oct;63(10):3136-41 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21800283
- ↑ 9.0 9.1 Li X, Meng X, Timofeeva M et al Serum uric acid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies. BMJ. 2017 Jun 7;357:j2376. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28592419 Free PMC Article
- ↑ 10.0 10.1 Singh JA, Cleveland JD. Comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in older adults: An analysis of Medicare claims data. Ann Rheum Dis 2017 Jun 5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28584186
- ↑ 11.0 11.1 11.2 11.3 Major TJ, Topless RK, Dalbeth N, Merriman TR. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ 2018;363:k3951. Oct 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30305269 https://www.bmj.com/content/363/bmj.k3951
Watson L, Roddy E The role of diet in serum urate concentration. BMJ 2018;363:k4140. Oct 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30305276 https://www.bmj.com/content/363/bmj.k4140 - ↑ 12.0 12.1 12.2 NEJM Knowledge+ Hematology