Mechanisms for hyperuricemia:
(1) excessive release of uric acid
(2) impaired excretion of uric acid by renal tubular cells
Excessive release of uric acid may occur from:
(1) alcohol abuse (which also interferes with excretion)
(2) fructose
(3) warfarin
(4) vitamin B12
(5) cytotoxic drugs used for the chemotherapy of tumors
Impaired uric acid excretion may occur with:
(1) thiazide diuretic
(2) furosemide or other loop diuretic
(3) low dose salicylate/aspirin therapy (< 2 g per day; uricosuric at high doses)
(4) cyclosporine
(5) niacin (nicotinic acid)
(6) ethambutol
(7) pyrazinamide
(8) didanosine
(9) alcohol abuse (which also promotes excessive release of urates)
(10) levodopa
(11) angiotensin
(12) vasopressin
(13) laxatives
(14) nitroglycerine
(15) methoxyflurane
(16) probenicid in low doses (uricosuric at usual doses)
Drugs that may cause uric acid kidney stones or gouty arthritis in some individuals when starting therapy:
(1) allopurinol
(2) sulfinpyrazone
