Abstract
The renal handling of urate has been studied in 32 patients with gouty nephropathy and in 32 non-gouty nephropathic control patients,by evaluating the filtered urate Load, uric acid excretion, uric acid clearance and uric acid excretion fraction.
As gouty patients have a significantly higher filtered urate load,they present a mean daily urinary excretion of uric acid which is comparable to that of non gouty patients matched for age and glomerular filtration rate. This suggests the existence of on impairment in the renal excretion of uric acid, which is confirmed by the significantly lower uric acid clearance and uric acid excretion fraction.
Furthermore, while in non-gouty patients a significant inverse correlation exists between creatinine clearance and uric acid excretion fraction values, this evidence is lacking in gouty patients, supporting the hypothesis of a renal impairment in the genesis of their hyperuricemia. In addition, since this pattern is also evident after normalizing the uricemia with allopurinol in gouty patients, the renal impairment in uric acid excretion does not appear to be secondary to the increased filtered load potentially saturating urate tubular secretion, but rather related to a primitive alteration in the renal system.
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Passavanti, G., Buongiorno, E., Lozupone, V.A., Spadavecchia, F., Coratelli, P. (1991). Renal Impairment in Uric Acid Excretion in Patients with Primary Gout. In: Amerio, A., Coratelli, P., Massry, S.G. (eds) Tubulo-Interstitial Nephropathies. Developments in Nephrology, vol 31. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3892-9_8
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