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MSK Wednesday
Wed
16
Accounting
Pre-School
12/09/2010

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Cards

Term
Which of the following does not inhibit URAT1?
Lostartan, high-dose salicylates, or Lactate
Definition
Lactate promotes reabs of urate through Lactate/Uric acid exchange at the URAT1 transporter.
Term
Name 3 genetic conditions predisposing to uric acid overproduction.
Definition
NOTE: PCKD IS A GENETIC CONDITION => UNDERSECRETION OF URIC ACID!
1) Glucose-6-phosphatase deficiency (glycogen storage disease type I)
2) Hypoxanthine guanine phosphoribosyltransferase deficiency (HGPRT) metabolizes purines so if you don’t have it you => uric acid
3) PRPP-synthetase superactivity
Term
Name 3 causes of UA o/production
Definition
Excessive purine intake
Ethanol
Drugs: nicotinic acid, warfarin, chemotherapy (tumor lysis) through massive tissue destruction
Obesity
Malignancies (myeloproliferative, lymphoproliferative)
Psoriasis
Hemolytic anemia
Tissue destruction (hypoxia, ischemia, trauma)
Term
What's more likely for developing gout? Underexcretion or overproduction? What are 3 common non-genetic causes?
Definition
Decreased GFR
Organic acidosis
Lead nephropathy
Drugs
Term
Which of the following drugs does not cause uric acid undersecretion?
Cyclosporine, sulfipyrizone, HCTZ, ASA?
Definition
Sulfipyrizone inhibits the URAT1.
Cyclosporin
Reduced GFR
Reduces urate secretion
Aspirin
Low dose (eg. 81 mg): inhibits urate secretion
High dose (>3g): decreases tubular reabsorption
Diuretics
Volume depletion -> increased reabsorption
Thiazides interfere with secretion
Term
Describe the cascade of hyperuricemia leading to a gout attack.
Definition
The Inflammasome: Cytosolic complex that activates IL-1β
Requires recruitment and activation of inflammatory caspases (caspase-1)
Responds to “danger signals” (innate immunity)
but we still don't know why the foot is the main target!!!
Term
Between gout episodes, the body's and joint's uric acid/crystal load decreases. T/F
Definition
False.
Term
Before you see chronic hyperuricemia nephropathy, you will always see gout arthritis. True
Definition
True
Term
Gout crystals are blue when perpendicular, yellow/orange/red when parallel. T/F
Definition
TRUE...Bloody Perps Yanked my apParel
Term
A HTNsive patient gets his bloodwork done and you find that he is hyperuricemic. What do you do?
Definition
No treatment? Is this correct K-dawg?
b/c technically it's asymptomatic right?
Term
Which of the following is not an indication for UA lowering medication?
Tophaceous gout
Erosive gout
Hypertension
Unacceptably frequent attacks (>3-4/year)
Nephrolithiasis
Serum uric acid >12 with other risk factors for gout or nephrolithiasis
Definition
HTN
Term
Name two medicines for treating undersecretion.
Definition
Suppress URAT1 -> decreases tubular reabsorption
Probenecid, losartan, fenofibrate.
CAVEAT: they require ADEQUATE GFR!!! and also Increases risk of uric acid stone formation/ urinary crystallization
Term
Tx for Overproduction?
Definition
Xanthine Oxidase inhibitors...b/c they act on the two precursors to UA.
or Uric oxidase to break down urate (Uricase to convert UA to allantoin and manage tumor lysis syndrome)
Term
What is a significant complication of a XO inhibitor for overproduction?
Definition
allopurinol hypersensitivity syndrome...should only give it to people who have SYMPTOMATIC huricemia
Term
You are puzzled b/c a patient with gout symptoms and attacks only has a uric acid level of 6.5. What are reasons for this? How do you go about figuring out what's the cause of his flares?
Definition
1) 1/3 of px w/ gout have <7 UA levels
2) Pseudogout aka Calcium pyrophosphate deposition disease
3) Joint aspiration
Crystals more rhomboid
Weakly positive birefringence
Term
you find on joint aspiration analysis rhomboid crystals and weak birefringence. What's not a good treatment for this old chap?
NSAIDs
Uricase
Steroids
Allopurinol
Colchicine
Treat associated disorders (hemachromatosis, hyperparathyroidism
Definition
uricase and allopurinol
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