Gout and Hyperuricemia Day 1 Flashcards
What is Gout?
hyperuricemia. It is recurrent attacks of aacute arthritis associated with urate crystals in synovial fluid. The crystals deposit in tissues in and around joints. It is an intestinal renal disease. It is uric acid nephrolithiasis
What is the epidemiology of gout?
men>women
peak 30 - 50 years
“disease of kings”
What are the risk factors of Gout?
older are male hyperuricemia obesity HTN DM CKD Alcohol intake high red meat or fish intake
What is the pathophysiology of uric acid?
produced from purine degradation. It is a waste product with no physiologic purpose
What is the pathophysiology of uricase?
enzyme that breaks down uric acid into soluble allantoin
What does hyperuricemia occur from?
overproduction of uric acid and underexcretion of uric acid
What 3 sources do purines come from?
diet
conversion of nucleic acid to purine nucleotides
De Novo synthesis of purine bases
What can cause an over production of uric acid?
purines and 2 enzyme abnormalities
What causes under excretion on uric acid?
multiple factors
How does uric acid get eliminated?
urine and enzyme break down in GI tract
What is urine excretion determined by?
Glomerular excretion
tubular secreation
tubular reabsorption
postsecretory reabsorption
What medications that decrease Uric acid excretion?
diuretics nicotinic acid salicylates ethanol pyrazinamide levodopa ethambutol cytotoxic drugs cyclosporine
How do you evaluate hyperuricemia?
determine if over producer or underexcretor
What determines if you are an underexcretor of uric acid?
purine free diet for 3-5 days and <600 mg/day excreted
What determines if you are an overproducer of uric acid?
purine free diet for 3-5 days and >600 mg/day excreted
Normal diet with an excretion of >1000 mg/day