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Flashcards in Gout- P Deck (32):
1

Uric acid is the breakdown product of _______ and therefore depends directly on both _______ and ______..

purine production and purine intake

2

The balance between ________ and ______ determines the serum urate levels.

production and excretion

3

In individuals with high serum urate levels, how might urate be deposited?

Either occultly or in the form of appreciable masses (tophi)

4

T or F. Underexcreors have a normal rate of exretion.

True

5

______ play a central role in the exretion of urate by the kidney.

OATs

6

Normally, uric acid is completely broken down by _____.

bacteria in the colon

7

What 2 mutations are known to cause increase in uric acid?

LOF of HGPRT (also causes Lesch-Nyhan)

GOF of PRPP

8

T of F Dehydration can trigger gout attack

T

9

T or F MI promotes hyperuricemis.

T

10

What drugs promote hyperuricemia?

Diuretics (loop and thiazides)

Drugs in the treatment of TB like ethambutol and pyrazinamide

Salicylates, nicotininc acids, cyclosporing, ethanol, CSF

11

What does fructose do to uric acid levels?

It turns up xanthine production--> raises levels

12

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.

True

13

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

14

What will WBC count be in gouty attack?

High, 95% neutrophils

15

Propagation of acute gouty response is activated by ______.

neutrophils

16

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

17

What immunologically happens when crystals are not coated?

Cell lysis

18

T or F. Gouty attack triggers explosive increase in LTB4. 

True

19

Individuals who are hyperuricemic should be screened for what?

hypertension, CAD, diabetes, obesity, alcoholism

20

When do serum uric acid levels increase in men and women?

men- puberty

Women- menopause

21

What is the highest incidence age of gout? What does this mean when compared to age of increasing levels of uric acid?

Men: 30-45

Women 55-70

The means there is a lengthy asymptomatic phase

22

What does estrogen therapy do for uric acid?

decreases the rise in menopausal women

23

Certain foods clearly promote hyperuricemia and gout.  This includes _____.

ALcohol (beer), seafood, red meat

24

T or F. Rare forms of early hyperuricemia and gout have a clear genetic and metobolic basis.  

T

25

What are the stages of gout?

Asymptomatic hyperuricemia

Acute and intercritical gout

chronic gouty arthritis 

26

The DDx for acute gout is usually _____.

Infectious arthritis or other crystal induced synovitis like pseudogout

27

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

28

In untreated gout, what is the prevalence of nephrolithiasis?

20%

29

What are the 3 mutations of renal disease associated with gout?

FJHN, MCKD 1, MCKD 2

30

Secondary hyperucicemia and gout are usually related to ________.

decreased renal urate clearance

31

What should you do to the dose of allopurinol in renal insuffieciency?

Decrease!!! Dose is based on Creatinine clearance

32