Skip to main content
SpringerLink
Log in

Gout and uric acid nephropathy: Some new aspects in diagnosis and treatment

  • Übersichten
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

It has been recognized that primary disorders of uric acid metabolism result from impaired renal excretion or increased endogenous production of uric acid. It has also been found that these two mechanisms do not comprise two distinct syndromes, but may each constitute a group of syndromes. Contrary to earlier as well as currently published reports we conclude from our clinical and experimental experience that the fraction of so-called over-producers is less than 1% of all patients with primary hyperuricaemia and gout. A procedure for the diagnosis of uric acid overproduction is suggested. The manifestation of hyperuricaemia and gout mainly depends on renal uric acid clearance and is greatly influenced by dietary habits in most of the patients. An impaired renal uric acid excretion results in an increased intestinal excretion; this partly compensates for the defect.

Normalization of serum uric acid should be achieved by dietary regimens with or without additional drug treatment, but not by drug treatment alone. With drug treatment xanthine oxidase inhibitors are preferable to uricosurics; no other xanthine oxidase inhibitor besides Allopurinol has been in clinical trial, however. Due to the enhancement of uric acid clearance with uricosurics, there are groups of patients who should not be treated with these drugs. Fixed combinations of Allopurinol and uricosurics should not be used. Drugs which have uricosuric as well as other pharmacologic properties are under investigation. So far they have not reached general clinical application.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Berkowitz D (1965) The effects of chlorophenoxyisobutyrate with and without androsterone on the serum lipids, fat tolerance and uric acid. Metabolism 14:966–975

    Article  CAS  PubMed  Google Scholar 

  • Boss GR, Seegmiller JE (1979) Hyperuricemia and gout. Classification, complications and management. N Engl J Med 300:1459–1468

    Article  CAS  PubMed  Google Scholar 

  • Brown GK (1977) General discussion: Allopurinol and purine transport. In: Purine and Pyrimidine Metabolism. Ciba Foundation Symposium 48:338–341

    Google Scholar 

  • Despopoulos A (1966) Congruence of excretary functions in liver and kidney: hippurates. Am J Physiol 210:760–764

    CAS  PubMed  Google Scholar 

  • Emmerson BT (1973) Alteration of urate metabolism by weight reduction. Aust NZ J Med 3:410–412

    Article  CAS  Google Scholar 

  • Emmerson BT (1980) Uricosuric diuretics. Kidney Int 18:677–685

    Article  CAS  PubMed  Google Scholar 

  • Faller J, Fox IH (1982) Ethanol-induced hyperuricemia. Evidence for increased urate production by activation of adenine nucleotide turnover. N Engl J Med 307:1598–1602

    Article  CAS  PubMed  Google Scholar 

  • Farebrother DA, Hatfield P, Simmonds HA, Cameron JS, Jones AS, Cadenhead A (1975) Experimental crystal nephropathy (one year study in the pig). Clin Nephrol 4:243–250

    Google Scholar 

  • Gibson T, Rodgers V, Court-Brown F, Simmonds HA (1981) Dietary intake of gouty patients. Ann Rheum Dis 40:515

    Article  Google Scholar 

  • Howard RP, Alaupovic P, Brusco OJ, Furman RH (1963) Effects of ethylchlorophenoxyisobutyrate alone or with androsterone (Atromid) on serum lipids, lipoproteins and related metabolic parameters in normal and hyperlipidemic subjects. J Atheroscler Res 3:482–499

    Article  CAS  PubMed  Google Scholar 

  • Keller Ch, Wolfram G, Zöllner N (1976) Die Behandlung von Hyperlipidämie und Hyperurikämie mit 2-Acetamidoäthyl-(4-chlorophenyl)-(3-trifluoro-methylphenoxy)-acetat (Halofenat), einem Derivat des Clofibrat. Arzneim Forsch 26:2221–2224

    CAS  Google Scholar 

  • Lang F, Greger R, Oberleithner H, Griss E, Lang K, Pastner D, Dittrich P, Deetjen P (1980) Renal handling of urate in healthy man, in hyperuricaemia and renal insufficiency: Circadian fluctuation, effect of water diuresis and of uricosuric agents. Eur J Clin Invest 10:285–292

    Article  CAS  PubMed  Google Scholar 

  • Löffler W, Gröbner W, Zöllner H (1980) Influence of dietary protein on serum and urinary uric acid. Adv Exp Med Biol 122A:209–213

    Article  Google Scholar 

  • Löffler W, Gröbner W, Zöllner N (1981) Nutrition and uric acid metabolism: plasma level, turnover, excretion. Fortschr Urol Nephrol 16:8–18

    Google Scholar 

  • Löffler W, Gröbner W, Medina R, Zöllner N (1982) Influence of dietary purines on pool size, turnover and excretion of uric acid during balance conditions. Isotope studies using15N-uric acid. Res Exp Med (Berl) 181:113–123

    Article  Google Scholar 

  • Löffler W, Gröbner W, Medina R, Zöllner N (1983 a) Isotope studies of uric acid metabolism during dietary purine administration. Adv Exp Med Biol. In press

  • Löffler W, Gröbner W, Wolfram G, Zöllner N (1983 b) Die endogene Harnsäuresynthese des Menschen. Verh Dtsch Ges Inn Med 89. In press

  • May P, Lux B (1977) Gichtbehandlung und -prophylaxe mit Urikosurika. Dtsch Ärzteblatt 74:1593–1599

    Google Scholar 

  • Nicholls A, Scott JT (1972) Effect of weight-loss on plasma and urinary levels of uric acid. Lancet II:1223–1224

    Article  Google Scholar 

  • Nicholls A, Snaith ML, Scott JT (1973) Effect of oestrogen therapy on plasma and urinary levels of uric acid. Br Med J I:449–451

    Article  Google Scholar 

  • Phoon WH, Pincherle G (1972) Blood uric acid in executives. Br J Ind Med 29:334–337

    CAS  PubMed  PubMed Central  Google Scholar 

  • Ravenscroft PJ, Hall GR, Ahokas JT, Emmerson BT, Tobert JA (1980) Indacrinone: Modification of diuretic, uricosuric, and kaliuretic actions by Amiloride. Clin Pharmacol Ther 28:45–51

    Article  CAS  PubMed  Google Scholar 

  • Seegmiller JE, Grayzel AJ, Laster L, Liddle L (1961) Uric acid production in man. J Clin Invest 40:1304–1314

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Seegmiller JE, Rosenbloom FM, Kelley WN (1967) Enzyme defect associated with a sex — linked human neurological disorder and excessive purine synthesis. Science 155:1682–1684

    Article  CAS  PubMed  Google Scholar 

  • Simmonds HA, Rising TJ, Cadenhead A, Hatfild PJ, Jones AS, Cameron JS (1973) Radioisotope studies of purine metabolism during administration of guanine and Allopurinol in the pig. Biochem Pharmacol 22:2553–2563

    Article  CAS  Google Scholar 

  • Simmonds HA, Warren DJ, Cameron JS, Potter CF, Farebrother DA (1980) Familial gout and renal failure in young women. Clin Nephrol 14:176–182

    CAS  PubMed  Google Scholar 

  • Simmonds HA, Gibson T, Huston GJ, Webster DR, Rodgers AV, Munro J (1983) Tophaceous gout resistant to Allpurinol therapy: poor compliance or non-response. Adv Exp Med Biol. In press

  • Sorensen LB (1980) Gout secondary to chronic renal disease: studies on urate metabolism. Ann Rheum Dis 39:424–430

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Spann W (1982) Diät. In: Zöllner N (ed) Hyperurikämie und Gicht, Vol. 5. Springer, Berlin, Heidelberg, New York, pp 8–37

    Chapter  Google Scholar 

  • Sperling O, Persky-Brosh S, Boer P, de Vries A (1973) Human erythrocyte phosphoribosylpyrophosphate synthetase mutationally altered in regulatory properties. Biochem Med 7:389–395

    Article  CAS  PubMed  Google Scholar 

  • Talbott JH (1981) It's gout until proven otherwise. Curr Rheumatol 2:1–7

    Google Scholar 

  • Van Goor W, Kooiker CJ, Dorhourt Mees EJ (1971) An unusual form of renal disease associated with gout and hypertension. J Clin Pathol 24:354–359

    Article  PubMed  PubMed Central  Google Scholar 

  • Warren DJ, Simmonds HA, Gibson T, Naik RB (1981) Familial gout and renal failure. Arch Dis Child 56:699–704

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wyngaarden JB (1982) Inherited disorders of purine metabolism. Verh Dtsch Ges Inn Med 88:1254–1259

    CAS  Google Scholar 

  • Yü TF, Berger L (1982) Impaired renal function in gout. Its association with hypertensive vascular disease and intrinsic renal disease. Am J Med 72:95–100

    Article  PubMed  Google Scholar 

  • Zöllner N, Gröbner W (1970) Der unterschiedliche Einfluß von Allopurinol auf die endogene und exogene Uratquote. Eur J Clin Pharmacol 3:56–58

    Article  Google Scholar 

  • Zöllner N, Gröbner W (1977) Dietary feedback regulation of purine and pyrimidine biosynthesis in man. Ciba Foundation Symposium 48:165–178

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Poliklinik der Universität München, Germany

    W. Löffler & W. Gröbner

  2. Purine Laboratory, Clinical Science Laboratories, Guy's Hospital, London

    H. A. Simmonds

Authors
  1. W. Löffler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. A. Simmonds
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Gröbner
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Dedicated to Prof. Nepomuk Zöllner on the occasion of his 60th birthday

Rights and permissions

Reprints and permissions

About this article

Cite this article

Löffler, W., Simmonds, H.A. & Gröbner, W. Gout and uric acid nephropathy: Some new aspects in diagnosis and treatment. Klin Wochenschr 61, 1233–1239 (1983). https://doi.org/10.1007/BF01540471

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01540471

Key words

Search

Navigation