Elevation in total body uric acid may follow increased dietary intake, increased production and/or decreased excretion. Increasing urinary excretion can help reduce accumulation and potential toxicity.


Urinary excretion of uric acid is affected by dietary intake of purines. On an average Western diet < 250 mg per day would be considered low.


Hereditary disorders associated with decreased urinary urate excretion:

(1) hereditary tubular disorder (decreased secretion and/or increased resorption)

(2) Bartter syndrome (hypokalemic alkalosis, increased plasma aldosterone and renin)

(3) Down syndrome (trisomy 21)


Acquired disorders:

(1) chronic renal insufficiency

(2) dehydration

(3) diabetes insipidus

(4) eclampsia or pre-eclampsia

(5) folic acid deficiency

(6) hyperparathyroidism

(7) hypothyroidism

(8) lactic acidosis

(9) diabetic ketoacidosis or other organic acidemia

(10) obesity

(11) polycystic renal disease

(12) starvation

(13) sarcoidosis


Toxin exposure

(1) beryllium poisoning

(2) lead poisoning


Medications associated with decreased urinary urate excretion:

(1) cyclophosphamide

(2) diuretics, especially thiazide

(3) ethambutol

(4) ethyl alcohol

(5) laxative abuse (associated with alkalosis)

(6) levodopa

(7) methoxyflurane

(8) pyrazinamide

(9) salicylates (in low doses)


Discontinuation of a uricosuric drug will be associated with a relative decrease in urate excretion.


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