Gout and diuretics

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Use of loop and thiazide diuretics is associated with gout, as they induce hyperuricaemia by increasing urate reabsorption. However this is not necessarily a direct action of the diuretics. Rather hyperuricaemia occurs when diuretics produce sufficient salt and water loss as to result in volume contraction and it is the volume contraction that causes urate reabsorption at the proximal tubule<ref>[[Pubmed:4309843|Steele TH, Oppenheimer S. Factors affecting urate excretion following diuretic administration in man. The American journal of medicine. 1969;47:564-74.]]</ref>. Accordingly it is the patients base line urate status before introduction of any diuretic that appears to be important<ref>[[Pubmed:16291814|Janssens HJ, van de Lisdonk EH, Janssen M, van den Hoogen HJ, Verbeek AL. Gout, not induced by diuretics? A case-control study from primary care. Annals of the rheumatic diseases. 2006;65:1080-3.]] <small>([http://dx.doi.org/10.1136/ard.2005.040360 Direct link] &ndash; subscription may be required.)</small></ref> with to date the exception of [[bumetanide]]. There is good evidence that this drug is actually uricosuric<ref>[[Pubmed:2049588|Hopkinson N, Doherty M. In patients with chronic cardiac failure who have diuretic induced gout, are
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certain diuretics less prone at causing problems? British journal of rheumatology. 1991;30:225.]]</ref>.
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Accordingly there is a predictable dose response behaviour both with dose of an individual diuretic and the worsening of hyperuricaemia when combination therapy is used.
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[[category:rheumatology]][[Category:Metabolic disorders]][[category:nephrology]][[Category:Diuretics]]
[[category:rheumatology]][[Category:Metabolic disorders]][[category:nephrology]][[Category:Diuretics]]

Latest revision as of 00:01, 11 November 2006

Use of loop and thiazide diuretics is associated with gout, as they induce hyperuricaemia by increasing urate reabsorption. However this is not necessarily a direct action of the diuretics. Rather hyperuricaemia occurs when diuretics produce sufficient salt and water loss as to result in volume contraction and it is the volume contraction that causes urate reabsorption at the proximal tubule[1]. Accordingly it is the patients base line urate status before introduction of any diuretic that appears to be important[2] with to date the exception of bumetanide. There is good evidence that this drug is actually uricosuric[3].

Accordingly there is a predictable dose response behaviour both with dose of an individual diuretic and the worsening of hyperuricaemia when combination therapy is used.

References