What are the causes of uric acid underexcretion in hyperuricemia?

Updated: Nov 03, 2020
  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Causes of uric acid underexcretion include the following:

  • Idiopathic

  • Familial juvenile gouty nephropathy: This is a rare autosomal dominant condition characterized by progressive renal insufficiency. Affected persons have a low fractional excretion of urate (typically 4%). Kidney biopsy findings indicate glomerulosclerosis and tubulointerstitial disease but no uric acid deposition.

  • Kidney insufficiency: Kidney failure is one of the more common causes of hyperuricemia. In chronic kidney disease, the uric acid level does not generally become elevated until the creatinine clearance falls below 20 mL/min, unless other contributing factors exist. This is due to a decrease in urate clearance as retained organic acids compete for secretion in the proximal tubule. In certain kidney disorders, such as medullary cystic disease and chronic lead nephropathy, hyperuricemia is commonly observed even with minimal kidney insufficiency.

  • Metabolic syndrome: This syndrome is characterized by hypertension, obesity, insulin resistance, dyslipidemia, and hyperuricemia, [13]  and is associated with a decreased fractional excretion of urate by the kidneys.

  • Drugs: Causative drugs include diuretics, low-dose salicylates, cyclosporine, pyrazinamide, ethambutol, levodopa, and nicotinic acid.

  • Hypertension

  • Acidosis: Types that cause hyperuricemia include lactic acidosis, diabetic ketoacidosis, alcoholic ketoacidosis, and starvation ketoacidosis.

  • Preeclampsia and eclampsia: The elevated uric acid associated with these conditions is a key clue to the diagnosis because in healthy pregnancies, uric acid levels are lower than normal.

  • Hypothyroidism

  • Hyperparathyroidism

  • Sarcoidosis

  • Lead intoxication (chronic): History may reveal occupational exposure (eg, lead smelting, battery and paint manufacture) or consumption of moonshine (ie, illegally distilled corn whiskey) because some, but not all, moonshine was produced in lead-containing stills).

  • Trisomy 21

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