Hyperuric acid metabolism

Introduction

Introduction Hyperuricemia is caused by hyperuricemia. Hyperuricemia, also known as gout, is a group of diseases caused by dysbial metabolic disorders. Its clinical features are hyperuricemia and the resulting recurrent attacks of gouty acute arthritis and tophi deposits. Chronic arthritis and joint deformity, often involving the kidney caused by chronic interstitial nephritis and uric acid kidney stones. The disease can be divided into two major categories: primary and secondary. The cause of primary disease is mostly unclear due to a small number of enzyme defects. It is often accompanied by hyperlipidemia, obesity, diabetes, hypertension, arteriosclerosis and crown. Heart disease, etc., is a hereditary disease.

Cause

Cause

To determine hyperuricemia is excessive uric acid clearance, uric acid clearance or urinary uric acid concentration and urine uric anhydride concentration. Urinary clearance rate, uric acid anhydride clearance ratio: 5% or less is uric acid excretion disorder, 5% to 12% is mixed type, that is, both uric acid production and uric acid excretion disorder, more than 12% of uric acid synthesis. The ratio of urinary uric acid concentration and urinary uric anhydride concentration: 0.4%~0.5% is uric acid excretion disorder; 0.4%~0.8% is mixed type, and 0.8% or more is excessive uric acid synthesis. Excessive synthesis of uric acid can be divided into two major categories: primary and secondary. The primary is uric acid over-producing, enzyme deficiency, and secondary is the result of massive decomposition of nucleic acids in blood diseases, tumors, burns, etc. Excretory disorders can also be divided into primary and secondary, primary is mostly idiopathic or hereditary; secondary is more common in renal dysfunction, dehydration, hyperthyroidism, acidosis, etc., in addition, mixed More common in alcohol, sorghum, high-calorie diet, after strenuous exercise, obesity and so on.

Examine

an examination

Related inspection

Kidney ultrasound examination kidney CT examination routine urine function test

Diagnostic points

(1) more common in male patients with middle-aged or older, often with gouty arthritis or gout nodules, urinary acidic urinary tract stones.

(2) urinary and renal function tests showed chronic interstitial nephritis.

(3) increased uric acid in the blood, male > 420umol / L, female > 360umol / L, uric acid enzyme method.

(4) Acute uric acid nephropathy is found in chemotherapy for malignant tumors, often manifested as acute renal failure.

Diagnosis

Differential diagnosis

1. Chronic pyelonephritis: Chronic pyelonephritis is often accompanied by frequent urination, urgency, dysuria and other symptoms, while uric acid nephropathy is about 60% with urinary tract infections, especially those caused by uric acid stone obstruction, but chronic pyelonephritis Nephritis normal blood uric acid, help identify.

2. Kidney stones: Kidney stones can be caused by urinary tract infection of foreign bodies, water and electrolyte disorders, etc., uric acid stones are one of them, but there is hyperuricemia, which is different from other stones, and X-ray examination of uric acid stones is not developed.

3. Chronic renal failure: Chronic renal failure may be accompanied by hyperuricemia, but the lesion is mainly in the glomerulus, glomerular filtration dysfunction occurs before renal tubular dysfunction, no history of gout, rarely Gouty arthritis occurs, and uric acid nephropathy is in the renal interstitial medulla, renal tubular dysfunction precedes glomerular dysfunction, blood uric acid and serum creatinine are not proportional, blood uric acid/creatinine >2.5 (in Mg/dl) 24-h uric acid excretion increased, often accompanied by uric acid stones and severe joint lesions or tophi.

4. Acute renal failure: acute renal failure is characterized by oliguria, anuria and rapid azotemia, similar to the clinical manifestations of acute hyperuricemia nephropathy, but acute hyperuricemia nephropathy 24h uric acid The discharge increased, urine test has polymorphous crystals accompanied by pyuria, hematuria, the ratio of uric acid and creatinine>1, and the ratio of uric acid and creatinine in acute renal failure caused by other causes.

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