Hyperuricemia

Aka: Hyperuricemia

1. See Also
   1. Uric Acid
   2. Gout
2. Pathophysiology: Asymptomatic Hyperuricemia
   1. Treat only if 24 hour Uric Acid excretion >1000 mg
   2. Over 95% with elevated Uric Acid remain asymptomatic
3. Decreased renal excretion of Uric Acid (90%)
   1. Primary idiopathic Hyperuricemia
   2. Chronic Renal Insufficiency
   3. Polycystic Kidney Disease
   4. Diabetes Insipidus
   5. Hypertension
   6. Dehydration or starvation ketosis
   7. Acidosis
      1. Lactic Acidosis
      2. Diabetic Ketoacidosis
   8. Down Syndrome
   9. Lead nephropathy or Lead Poisoning
   10. Berylliosis
   11. Sarcoidosis
   12. Hyperparathyroidism
   13. Hypothyroidism
   14. Pregnancy Induced Hypertension
   15. Bartter's Syndrome
   16. Medications and other intakes
       1. Acute Alcohol ingestion
       2. Diuretics
          1. Limit Hydrochlorothiazide to 25 mg/day
          2. Consider other antihypertensives
       3. Cyclosporine
       4. Nicotinic Acid
       5. Salicylates (less than 2 grams per day)
       6. Pyrazinamide
       7. Ethambutol
4. Overproduction of Uric Acid (10%)
   1. Inborn error of metabolism
      1. HGPRTase deficiency
         1. Hypoxanthine-guanine phosphoribosyl-transferase
      2. PRPP synthase overactivity
         1. Phosphoribosyl pyrophosphate synthetase
   2. Hemolysis
   3. Myeloproliferative disorder
   4. Lymphoproliferative disorder
   5. Solid tumors
   6. Polycythemia Vera
   7. Medications
      1. Strong response to Chemotherapy or cytotoxic agents
      2. Pancreatic extracts
      3. Vitamin B12
   8. Alcohol intake (especially beer)
   9. Purine-rich diet
      1. See Purine Content in Foods
   10. Obesity
   11. Severe Psoriasis
   12. Tissue necrosis
5. Combination: Overproduction and decreased excretion
   1. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)
   2. Fructose-1-Phosphate Aldolase Deficiency
   3. Shock
   4. Alcohol ingestion