Hyperuricaemia

Question 1

High levels of uric acid may be seen secondary to- ?

Answer 1

• Increased cell turnover (ot high synthesis)
• Reduced renal excretion of uric acid

Question 2

Is hyperuricaemia symptomatic or asymptomatic?

Answer 2

• Both are possible
• Hyperuricaemia may be found in asymptomatic patients who have not experienced attacks of gout

Question 3

Hyperuricaemia >>> possible associations

Answer 3

• Hyperlipidaemia
• HTN (hypertension)
• Metabolic syndrome

Question 4

Causes of hyperuricaemia due to increased synthesis (or increased cell turnover)

Answer 4

• Lesch-Nyhan disease (XR)
• Myeloproliferative disorders: PRV, CML, ET, Myelofibrosis
• Lymphoproliferative disorders: CLL, Lymphoma (HL, NHL)
• Psoriasis (Severe form)
• Cytotoxics (→ tumour lysis syndrome → hyperuricaemia)
• Diet rich in purines
• Exercise

Question 5

Causes of hyperuricaemia due to reduced renal excretion of uric acid

Answer 5

• Drugs:
  
  • Low dose aspirin
  • Diuretics (thiazides only) (increases Na excretion, reduces uric acid excretion)
  • Pyrazinamide
  • Acetazolamide
• Pre-eclampsia
• Renal failure (mainly CKD)
• Alcohol (intake)
• Lead toxicity (intake)

Question 6

Dangers/complications of hyperuracaemia (over years)

Answer 6

​low to higher risk ( = above downwards) >>>

• Stroke
• Heart diseases
• Liver diseases
• Kidney failure

​Risk is more when uric acid is >8.5mg/dL (or >742umosl/L) over years

Highest risk is for kidney failure, which has risk over 8years or more