Renal Handling of Uric Acid
The pathogenesis of gout has intrigued physicians for centuries. A pathogenetic role for the kidney was first suggested by Garrod more than 125 years ago (1). During the ensuing century, many studies were performed attempting to measure urate excretion in patients with gout. However, the role of the normal kidney in maintaining urate homeostasis was not clearly defined. The first comprehensive study designed to investigate the mechanism of urate handling by the normal kidney, employing contemporary principles of renal physiology, was carried out by Berliner and colleagues in 1950 (2). They concluded that “the difference between the clearance of urate and the clearance of inulin must be due to either non-filterability of a large fraction of the plasma urate, to tubular reabsorption of a major fraction of the filtered urate, or to some combination of these two”. It is remarkable that in the same year, Praetorius and Kirk described a patient with marked hypouricemia, who had a urate to inulin clearance ratio of 1.46 (3). These authors concluded that urate was either secreted or synthesized in the kidney.
KeywordsUric Acid Fractional Excretion Renal Plasma Flow Renal Handling Uric Acid Excretion
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