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[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.