Gout Flashcards
What is an inflammatory disease resulting from the formation of rate crystals in joints and soft tissues?
Gout
What can aggravate gout?
Genetics obesity age adult males or postmenopausal women hypertension diet (high purine, high fructose)
What disease states can aggravate gout?
Lesch-Nyhan syndrome
End stage renal disease
cancers (with cell lysis})
organ transplant
What medications can aggravate gout?
Thiazides (Use same transporters as uric acid) low dose ASA niacin immune suppressants cytotoxic agents (that cause cell lysis)
What is the concentration of uric acid that usually causes crystallization?
6.8mg/deciliter. About 7mg per deciliter.
Does hyperurecemia always cause gout?
Not necessarily. Wait to see symptoms before treating.
What are the disease phases in gout?
Acute (3-14 days per attack. Years between attacks)
Intermittent (Acute attacks 2 + x’s/year)
Chronic/advanced (changes in renal function, toe fie development - permanent crystals in joints). Usually in many joints at this point.
What does uric acid come from?
It comes from purines, which we obtain through organ meats (that are high in purines) or our cells breaking down.
Fructose facilitates the formation of AMP from ATP. It also comes from high fructose corn syrup. Starts us down the pathway. Changing diet is a good first step, but rarely enough.
When do gout attacks usually happen?
At night
Where does it usually occur?
In toes, ankles or elbows. Low-grade fever sometimes occurs.
What should you do for treatment when someone only has acute attacks?
You do not start chronic therapy, but could treat as you see the symptoms.
hypoxanthine uses what enzyme?
Xanthine oxidase to get xanthine
What enzyme does xanthine use?
Xanthine oxidase to get uric acid (or urate)
Where do the drugs that we have act?
They act on xanthine oxidase. An example
What strategy can animals take advantage of?
Uricase, which breaks urate down to allantoin to get of it.
Who cannot break rate down to allantoin?
Humans, apes, and dalmatians do not have uricase
Is there a way for humans to break down uric acid?
No, but in the last 5 years we have been able to make uricase. This is a possible treatment to get rid of uric acid.
What does Lesch-Neyhan syndrome mean?
Lack salvage pathways. Allows more things to head down the uric acid pathways.
How od humans naturally get rid of uric acid?
Through the urine.
What percentage of uric acid goes through glomerular filtration?
100% of uric acid goes through the glomerulus
What percentage of uric acid gets resorbed in the proximal convoluted tubule?
98% of uric acid
How does uric acid get back into the proximal convoluted tubule?
It is secreted back
Which transporters in the proximal convoluted tubule are highly involved in
URAT1
OAT4
What can uricoceric agents do?
They can enhance uric acid release into the urine
