The Blood Pressure in Gout

Rosenbloom, Jacob

doi:10.1001/jama.1918.26010260002005a

“…It is pertinent, therefore, to consider their incidence in patients with gout. In our series only eight had hypertension; in each of these it corresponded to the benign rather than the malignant type (30). K. He.…”

Section: Action Of Drugsmentioning

confidence: 48%

Renal Function in Patients With Gout 1

Coombs¹,

Pecora²,

Thorogood³

et al. 1940

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There are several theories of the pathogenesis of urate 2 accumulation in patients with gout. A disturbance of elimination of this substance by the kidneys is probably the most popular. This has been challenged, however, in a previous communication from this laboratory (1), since it appears to be inconsistent with certain experimental data. Whether or not this theory is valid, it deserves serious consideration because urates as naturally occurring end-products of purine metabolism are disposed of by the body largely by excretion through the kidneys. If one pursues the hypothesis to a logical conclusion, any defect of elimination might be inherited or it might be an acquired phenomenon following damage to the functioning units of the kidneys.The accepted theory (2, 3) of renal physiology in man assumes that urates are present in glomerular urine as are other ultrafiltrable substances and reabsorbed in part by the cells lining the tubules. If the kidneys were primarily at fault in the gouty diathesis, accumulation of urate might be attributed either to (a) a reduction of the number of functioning glomeruli or (b) an increased reabsorption by the tubules. Both of these phenomena are partially susceptible of quantitative analysis now that improved methods for the study of kidney function are available.A presentation and discussion of kidney function data, as determined by five experimental procedures, are contained in this communication. These include tests for the excretion of substances normally present in the body such as urea, creatinine, urate, sodium and chloride and for the excretion of foreign substances introduced parenterally such as phenolsulphonphthalein, neo-iopax 1 This investigation was supported in part by a grant from the Corn Industries Research Foundation.2 The term urate is preferable to uric acid in a consideration of acid-base equilibrium of biological media just as chloride is preferable to hydrochloric acid and phosphate is preferable to phosphoric acid. and inulin. Studies were made of normal persons and of patients suffering from diseases other than gout, as well as of patients with classical gout. The action of drugs used therapeutically in the treatment of acute and chronic gouty arthritis was investigated. SUBJECTSThirty-one persons acted as experimental subjects. Twenty-two were afflicted with gout; six were patients with diseases other than gout; three were normal persons. The patients with gout were selected without regard to extent of disease or duration of symptoms. It was necessary only that the criteria for the diagnosis of gout were satisfied (1, 4, 5) and that the patients consented to hospital admission for study. All except K. He. were males. Their ages varied from 28 to 81 years. Each patient had had two or more attacks of acute arthritis, and on two or more occasions the concentration of fasting serum urate had been greater than 6.0 mgm. per 100 cc. Osseous or cartilagenous tophi were suspected from the roentgenogram in thirteen. Subcutaneous tophi were present in seventeen....

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“…The frequent occurrence of hypertension and vascular lesions in gout is recorded by many authorities (Meakin 1939, Osler and McCrae 1925, Cecil 1943, Levine 1940 and Stotzer 1939, while Garcin (1939) gives a detailed description of the histology of the gouty kidney. Only Rosenbloom (1918) and Buckley (1937Buckley ( , 1938 state that this association is not constant, and often absent.Master and others (1943) have estimated that the incidence of hypertension in persons over 40 years of age in the general population is not more than 50 per cent. The term hypertension in their report denotes (1) a systolic pressure of 150 mm.…”

mentioning

confidence: 99%

“…The frequent occurrence of hypertension and vascular lesions in gout is recorded by many authorities (Meakin 1939, Osler and McCrae 1925, Cecil 1943, Levine 1940 and Stotzer 1939), while Garcin (1939) gives a detailed description of the histology of the gouty kidney. Only Rosenbloom (1918) and Buckley (1937Buckley ( , 1938 state that this association is not constant, and often absent.…”

mentioning

confidence: 99%

Gout and its effect on the cardio-vascular system

1946

American Heart Journal

0

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The characteristic feature that distinguishes gout from the other syndromes of rheumatic disease is an abnormality of uric acid metabolism. Uric acid exists in the body both as free acid and as the more soluble monosodium salt. Approximately half is endogenous in origin and the remainder is derived from digestion of nucleoproteins and nucleic acid in the food. The total amount of urate excreted in the urine is normally about 0-75-1-00 gramme per day, and the quantity is increased by ingestion of any type of protein and decreased by a high fat dieta mechanism utilized by Lockie and Hubbard (1935) and Lockie (1942) in order to test for gout by attempting to promote an acute attack in a suspected case by placing him on a ketogenic diet.Since the time of Thomas Sydenham (1683), himself a sufferer, gout has been blamed as one of the causes, or at least a concomitant, of kidney damage and renal calculus. The frequent occurrence of hypertension and vascular lesions in gout is recorded by many authorities (Meakin 1939, Osler and McCrae 1925, Cecil 1943, Levine 1940 and Stotzer 1939, while Garcin (1939) gives a detailed description of the histology of the gouty kidney. Only Rosenbloom (1918) and Buckley (1937Buckley ( , 1938 state that this association is not constant, and often absent.Master and others (1943) have estimated that the incidence of hypertension in persons over 40 years of age in the general population is not more than 50 per cent. The term hypertension in their report denotes (1) a systolic pressure of 150 mm. Hg or more at any time during observation, (2) a diastolic pressure of 96 mm. or more prior to an attack of coronary occlusion, (3) a diastolic pressure of 90 mm. or more during or after the attack, (4) marked enlargement of the heart without obvious cause. The application of these criteria shows that 69 per cent. of the patients afflicted with coronary occlusion had hypertension before the attack. The incidence in the general population, including men, women, and children, is much less than Master's figures. During the past ten years, 83,514 patients were admitted to one of our large local general hospitals. During a similar period 10,073 patients with either coronary insufficiency or coronary occlusion, and 1,819 patients with essential hypertension (with no demonstrable coronary disease), were admitted. Present InvestigationForty-six cases of typical gout are included in this study. All the patients have been observed and treated by the writer, and most of them have been observed over a period of several years. The age of a patient listed in Table 1 is the age at which the patient was first seen. Thirty-one patients had a normal blood pressure (

show abstract

“…The frequent occurrence of hypertension and vascular lesions in gout is recorded by many authorities (Meakin 1939, Osler and McCrae 1925, Cecil 1943, Levine 1940and Stotzer 1939, while Garcin (1939) gives a detailed description of the histology of the gouty kidney. Only Rosenbloom (1918) and Buckley (1937Buckley ( , 1938 state that this association is not constant, and often absent.…”

mentioning

confidence: 99%

Gout and its Effect on the Cardiovascular System

Gl¹

1945

Annals of the Rheumatic Diseases

3

0

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The characteristic feature that distinguishes gout from the other syndromes of rheumatic disease is an abnormality of uric acid metabolism. Uric acid exists in the body both as free acid and as the more soluble monosodium salt. Approximately half is endogenous in origin and the remainder is derived from digestion of nucleoproteins and nucleic acid in the food. The total amount of urate excreted in the urine is normally about 0-75-1-00 gramme per day, and the quantity is increased by ingestion of any type of protein and decreased by a high fat dieta mechanism utilized by Lockie and Hubbard (1935) and Lockie (1942) in order to test for gout by attempting to promote an acute attack in a suspected case by placing him on a ketogenic diet.Since the time of Thomas Sydenham (1683), himself a sufferer, gout has been blamed as one of the causes, or at least a concomitant, of kidney damage and renal calculus. The frequent occurrence of hypertension and vascular lesions in gout is recorded by many authorities (Meakin 1939, Osler and McCrae 1925, Cecil 1943, Levine 1940 and Stotzer 1939, while Garcin (1939) gives a detailed description of the histology of the gouty kidney. Only Rosenbloom (1918) and Buckley (1937Buckley ( , 1938 state that this association is not constant, and often absent.Master and others (1943) have estimated that the incidence of hypertension in persons over 40 years of age in the general population is not more than 50 per cent. The term hypertension in their report denotes (1) a systolic pressure of 150 mm. Hg or more at any time during observation, (2) a diastolic pressure of 96 mm. or more prior to an attack of coronary occlusion, (3) a diastolic pressure of 90 mm. or more during or after the attack, (4) marked enlargement of the heart without obvious cause. The application of these criteria shows that 69 per cent. of the patients afflicted with coronary occlusion had hypertension before the attack. The incidence in the general population, including men, women, and children, is much less than Master's figures. During the past ten years, 83,514 patients were admitted to one of our large local general hospitals. During a similar period 10,073 patients with either coronary insufficiency or coronary occlusion, and 1,819 patients with essential hypertension (with no demonstrable coronary disease), were admitted. Present InvestigationForty-six cases of typical gout are included in this study. All the patients have been observed and treated by the writer, and most of them have been observed over a period of several years. The age of a patient listed in Table 1 is the age at which the patient was first seen. Thirty-one patients had a normal blood pressure (

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The Blood Pressure in Gout

Abstract: transplants were made from each broth culture; partial tension growth was always rich, aerobic growth was always scant.

Cited by 5 publications

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Renal Function in Patients With Gout 1

Renal Function in Patients With Gout 1

Gout and its effect on the cardio-vascular system

Gout and its Effect on the Cardiovascular System

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