Abnormal Renal Urate Homeostasis in Systemic Disorders

Abstract

Abnormalities of renal handling of urate occur in a wide variety of physiological and pathological conditions and are mediated by factors including renal blood flow, glomerular filtration rate, urine flow rate, urinary constituents, metabolites, hormones and drugs. The determination of the aetiological factors in each abnormal situation is complex and the problem is discussed in relation to a variety of conditions including renal tubular disorders and metal intoxications, hypertension, toxaemia of pregnancy, glycogen storage disease, fructose administration, hereditary fructose intolerance, as well as obesity, regular alcohol consumption and hyperlipoproteinaemia. Apart from those diseases, usually genetically determined, which are associated with excessive production of urate, the most common causes of hyperuricaemia act at a renal level and result in a reduction in the net renal excretion of urate.

Haemodynamic correlates and prognostic significance of serum uric acid in adult patients with Eisenmenger syndrome

“…25 26 Ross and colleagues have shown that hyperuricaemia in cyanotic congenital heart disease is attributable to enhanced urate reabsorption secondary to abnormal intrarenal haemodynamics 26. An increase in lactate in hypoxic states has also been shown to inhibit tubular uric acid secretion 27. In the present study, serum uric acid was independently correlated with cardiac index and serum creatinine in multivariate analysis.…”

Associations among Lead Dose Biomarkers, Uric Acid, and Renal Function in Korean Lead Workers

“…In high-level lead exposure, urate clearance is decreased to a greater extent than can be explained by decreased glomerular filtration alone (Emmerson and Ravenscroft 1975). A defect in tubular secretion of urate is thought to be the primary factor involved (Ball and Sorensen 1969; Emmerson 1965; Emmerson and Ravenscroft 1975), although excessive tubular reabsorption (Emmerson et al 1971) and extrarenal mechanisms such as lead effects on porphyrin metabolism (Emmerson and Ravenscroft 1975) have also been considered. Associations between lead measures and uric acid have been examined in populations encompassing a wide range of lead doses (Table 7).…”

Renal Handling of Uric Acid

“…It would follow that secretion would be diminished in the presence of a decreased plasma urate concentration, or a decrease in renal plasma flow. In addition, a wide variety of hormones, metabolites and drugs decrease renal urate excretion, most likely through decreasing secretion (29).…”