II. Pathophysiology: Asymptomatic Hyperuricemia
III. Decreased renal excretion of Uric Acid (90%)
- Primary idiopathic Hyperuricemia
- Chronic Renal Insufficiency
- Polycystic Kidney Disease
- Diabetes Insipidus
- Hypertension
- Dehydration or Starvation Ketosis
- Acidosis
- Down Syndrome
- Lead nephropathy or Lead Poisoning
- Berylliosis
- Sarcoidosis
- Hyperparathyroidism
- Hypothyroidism
- Pregnancy Induced Hypertension
- Bartter's Syndrome
- Medications and other intakes
- Acute Alcohol ingestion
- Diuretics
- Limit Hydrochlorothiazide to 25 mg/day
- Consider other Antihypertensives
- Cyclosporine
- Nicotinic Acid
- Salicylates (less than 2 grams per day)
- Pyrazinamide
- Ethambutol
IV. Overproduction of Uric Acid (10%)
- Inborn error of metabolism
- HGPRTase deficiency
- Hypoxanthine-guanine phosphoribosyl-transferase
- PRPP synthase overactivity
- Phosphoribosyl pyrophosphate synthetase
- HGPRTase deficiency
- Hemolysis
- Myeloproliferative disorder
- Lymphoproliferative disorder
- Solid tumors
- Polycythemia Vera
- Medications
- Strong response to Chemotherapy or cytotoxic agents
- Pancreatic extracts
- Vitamin B12
- Alcohol intake (especially beer)
- Purine-rich diet
- Obesity
- Severe Psoriasis
- Tissue necrosis
V. Combination: Overproduction and decreased excretion
- Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)
- Fructose-1-Phosphate Aldolase Deficiency
- Shock
- Alcohol ingestion