Term
Which of the following does not inhibit URAT1?
Lostartan, high-dose salicylates, or Lactate |
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Definition
| Lactate promotes reabs of urate through Lactate/Uric acid exchange at the URAT1 transporter. |
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Term
| Name 3 genetic conditions predisposing to uric acid overproduction. |
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Definition
NOTE: PCKD IS A GENETIC CONDITION => UNDERSECRETION OF URIC ACID!
1) Glucose-6-phosphatase deficiency (glycogen storage disease type I)
2) Hypoxanthine guanine phosphoribosyltransferase deficiency (HGPRT) metabolizes purines so if you don’t have it you => uric acid
3) PRPP-synthetase superactivity |
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Term
| Name 3 causes of UA o/production |
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Definition
Excessive purine intake
Ethanol
Drugs: nicotinic acid, warfarin, chemotherapy (tumor lysis) through massive tissue destruction
Obesity
Malignancies (myeloproliferative, lymphoproliferative)
Psoriasis
Hemolytic anemia
Tissue destruction (hypoxia, ischemia, trauma) |
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Term
| What's more likely for developing gout? Underexcretion or overproduction? What are 3 common non-genetic causes? |
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Definition
Decreased GFR
Organic acidosis
Lead nephropathy
Drugs |
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Term
Which of the following drugs does not cause uric acid undersecretion?
Cyclosporine, sulfipyrizone, HCTZ, ASA? |
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Definition
Sulfipyrizone inhibits the URAT1.
Cyclosporin
Reduced GFR
Reduces urate secretion
Aspirin
Low dose (eg. 81 mg): inhibits urate secretion
High dose (>3g): decreases tubular reabsorption
Diuretics
Volume depletion -> increased reabsorption
Thiazides interfere with secretion |
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Term
| Describe the cascade of hyperuricemia leading to a gout attack. |
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Definition
The Inflammasome: Cytosolic complex that activates IL-1β
Requires recruitment and activation of inflammatory caspases (caspase-1)
Responds to “danger signals” (innate immunity)
but we still don't know why the foot is the main target!!! |
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Term
| Between gout episodes, the body's and joint's uric acid/crystal load decreases. T/F |
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Definition
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Term
| Before you see chronic hyperuricemia nephropathy, you will always see gout arthritis. True |
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Definition
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Term
| Gout crystals are blue when perpendicular, yellow/orange/red when parallel. T/F |
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Definition
| TRUE...Bloody Perps Yanked my apParel |
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Term
| A HTNsive patient gets his bloodwork done and you find that he is hyperuricemic. What do you do? |
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Definition
No treatment? Is this correct K-dawg?
b/c technically it's asymptomatic right? |
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Term
Which of the following is not an indication for UA lowering medication?
Tophaceous gout
Erosive gout
Hypertension
Unacceptably frequent attacks (>3-4/year)
Nephrolithiasis
Serum uric acid >12 with other risk factors for gout or nephrolithiasis |
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Definition
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Term
| Name two medicines for treating undersecretion. |
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Definition
Suppress URAT1 -> decreases tubular reabsorption
Probenecid, losartan, fenofibrate.
CAVEAT: they require ADEQUATE GFR!!! and also Increases risk of uric acid stone formation/ urinary crystallization |
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Term
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Definition
Xanthine Oxidase inhibitors...b/c they act on the two precursors to UA.
or Uric oxidase to break down urate (Uricase to convert UA to allantoin and manage tumor lysis syndrome) |
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Term
| What is a significant complication of a XO inhibitor for overproduction? |
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Definition
| allopurinol hypersensitivity syndrome...should only give it to people who have SYMPTOMATIC huricemia |
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Term
| You are puzzled b/c a patient with gout symptoms and attacks only has a uric acid level of 6.5. What are reasons for this? How do you go about figuring out what's the cause of his flares? |
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Definition
1) 1/3 of px w/ gout have <7 UA levels
2) Pseudogout aka Calcium pyrophosphate deposition disease
3) Joint aspiration
Crystals more rhomboid
Weakly positive birefringence |
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Term
you find on joint aspiration analysis rhomboid crystals and weak birefringence. What's not a good treatment for this old chap?
NSAIDs
Uricase
Steroids
Allopurinol
Colchicine
Treat associated disorders (hemachromatosis, hyperparathyroidism |
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Definition
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