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1, exogenous purine intake too much: high levels of uric acid and purine content in food is proportional to. Intake of food, 50% of RNA, 25% of DNA should be in the urine
In the form of uric acid excretion, strictly limit the amount of purine intake of serum uric acid can be reduced to 60μmol / L (1.0mg / dL), while urinary uric acid secretion decreased to 1.2mmol / d (200mg / d).
2, endogenous purine produced too much: endogenous purine metabolic disorders than exogenous factors is more important. Purines undergo an 11-step reaction from an acyclic to a cyclic de novo synthesis, where an abnormally high amount of enzyme causes excessive synthesis of the purine. Have found that:
1) phosphoribosyl pyrophosphate synthetase activity increased.
2) Hypoxanthine-guanine phosphoribosyltransferase deficiency.
3) Glucose 6-phosphatase deficiency.
3, increased purine metabolism: such as chronic hemolytic anemia, rhabdomyolysis, polycythemia, myeloproliferative diseases and chemotherapy or radiotherapy will produce high uric acid. Excessive exercise, epilepsy, glycogen storage disease III, V, VII, can accelerate muscle ATP degradation. Myocardial infarction, smoking, acute respiratory failure are also associated with accelerated APT degradation.
Second, the metabolism of purine substances in the body, leading to uric acid excretion to reduce persistent high uric acid in patients with 90% of renal dysfunction of uric acid.
In patients with hyperuricemia and gout, given different uric acid load, the ratio of urate clearance to glomerular filtration rate is lower than in the normal population. Reduction of uric acid secretion may be associated with decreased glomerular filtration rate, decreased tubular secretion or renal tubular reabsorption. Although high uric acid is always present in chronic kidney disease, the relationship between uric acid concentration and serum creatinine and blood urea nitrogen is unclear.
With the decline of renal function, per unit of glomerular uric acid secretion is increased, but basically the same tubular secretion, renal tubular reabsorption capacity is also reduced, renal extracellular uric acid clearance was significantly increased.
1, inhibition of tubular secretion: one of the most important mechanism. Drugs, poisoning, or endogenous metabolites inhibit uric acid excretion and / or reabsorption. This occurs when the anion transport system is inhibited, with two important inhibitors being lactate and ketoacid.
2, reduced glomerular filtration: uric acid levels can also be increased. One of the mechanisms is the reduction in filtration rate, which is the main cause of renal dysfunction or failure of hyperuricemia. Net increase in uric acid absorption can occur in the case of capacity reduction, which is one of the mechanisms diuretic-induced hyperuricemia.
3, tubular reabsorption increased: hyperuricemia can also be due to the secretory location of the distal reabsorption of lead. These can be seen when diabetes dehydration or diuretic treatment.
Third, the two factors exist in many patients at the same time, uric acid production and decreased excretion of two factors exist.
Such as glucose 6-phosphatase deficiency, hereditary lactose intolerance in patients. Alcohol can also make uric acid retention in two ways. Excessive alcohol intake accelerated hepatic degradation of ATP, increased uric acid output. Uric acid caused by alcohol also prevents uric acid excretion. High purine content of alcoholic beverages such as beer is also an important factor.
Fourth, other external factors, will lead to high uric acid
Drugs such as allopurinol tablets, allopurinol tablets inhibit uric acid synthesis of drugs, allopurinol and its metabolite oxypurine alcohol can inhibit xanthine oxidase, hypoxanthine and xanthine metabolism to prevent uric acid, thereby reducing the Uric acid production; such as the weather changes, as the temperature increases, uric acid solubility will increase, whereas the temperature will reduce urate crystals in the form of precipitation will also affect the uric acid concentration, more understanding of the reasons for high uric acid .
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