Uric acid is the breakdown product of _______ and therefore depends directly on both _______ and ______..
purine production and purine intake
The balance between ________ and ______ determines the serum urate levels.
production and excretion
In individuals with high serum urate levels, how might urate be deposited?
Either occultly or in the form of appreciable masses (tophi)
T or F. Underexcreors have a normal rate of exretion.
______ play a central role in the exretion of urate by the kidney.
Normally, uric acid is completely broken down by _____.
bacteria in the colon
What 2 mutations are known to cause increase in uric acid?
LOF of HGPRT (also causes Lesch-Nyhan)
GOF of PRPP
T of F Dehydration can trigger gout attack
T or F MI promotes hyperuricemis.
What drugs promote hyperuricemia?
Diuretics (loop and thiazides)
Drugs in the treatment of TB like ethambutol and pyrazinamide
Salicylates, nicotininc acids, cyclosporing, ethanol, CSF
What does fructose do to uric acid levels?
It turns up xanthine production--> raises levels
T or F. After the first gouty attack, gout tends to come back asymmetrically in multiple joints, which can make it easy to confuse with RA.
What are the uric acid nephrolithiasis risk factors?
1. increase uric acid excretion
2. Decrease urine volume
3. decrease urine pH
All of these --> uric acid as insoluble acid
What will WBC count be in gouty attack?
High, 95% neutrophils
Propagation of acute gouty response is activated by ______.
What happens with neutrophils when crystals are coated with Ig?
results in activation and release of inflammatory mediators like IL-1, IL-8, and TNF as well as ROS
What immunologically happens when crystals are not coated?
T or F. Gouty attack triggers explosive increase in LTB4.
Individuals who are hyperuricemic should be screened for what?
hypertension, CAD, diabetes, obesity, alcoholism
When do serum uric acid levels increase in men and women?
What is the highest incidence age of gout? What does this mean when compared to age of increasing levels of uric acid?
The means there is a lengthy asymptomatic phase
What does estrogen therapy do for uric acid?
decreases the rise in menopausal women
Certain foods clearly promote hyperuricemia and gout. This includes _____.
ALcohol (beer), seafood, red meat
T or F. Rare forms of early hyperuricemia and gout have a clear genetic and metobolic basis.
What are the stages of gout?
Acute and intercritical gout
chronic gouty arthritis
The DDx for acute gout is usually _____.
Infectious arthritis or other crystal induced synovitis like pseudogout
What conditions are associated with gout?
obesity, hypertriglyceridemia, glucose intolerance, metabolic syndrome, hypertension, atherosclerosis, hypothyroidism, renal insufficiency, nephrolithiasis, tumor lysis syndrome, alcohol use, lead intox, cyclosporine
In untreated gout, what is the prevalence of nephrolithiasis?
What are the 3 mutations of renal disease associated with gout?
FJHN, MCKD 1, MCKD 2
Secondary hyperucicemia and gout are usually related to ________.
decreased renal urate clearance
What should you do to the dose of allopurinol in renal insuffieciency?
Decrease!!! Dose is based on Creatinine clearance