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Objective To investigate clinical characteristics and renal uric acid excretion in early-onset gout patients.Methods Consecutive inpatients with primary gout were recruited between 2013 and 2017.The patients with gout onset younger than 30 were defined as early-onset group while the others were enrolled as control group.Clinical characteristics and uric acid (UA) indicators were compared between two groups.Results Among 202 recruited patients,the early-onset group included 36 patients (17.8％).Compared with control group,the early-onset group presented more patients with obesity [13 patients (36.1％) vs.22 patients (13.3％),P＜0.05],significantly higher serum UA level [(634± 124)μmol/L vs.(527± 169).μmol/L] and glomerular load of UA[(7.2±2.8)mg· min-1 · 1.73m-2 vs.(4.4±2.2)mg· min-1 · 1.73m-2] and estimated glomerular filtration rate (GFR) [(83±21)ml· min-1 · 1.73m-2 vs.(67±21)ml· min-1 · 1.73m-2] (all P＜ 0.05),lower fractional excretion of UA [4.4％ (3.4％,6.1％) vs.7.2％ (5.2％,9.6％),P＜0.05],whereas 24h urinary UA excretion was comparable [(2 788±882)l,μmol/1.73m2 vs.(2 645±1 140)μmol/1.73m2,P=0.274].Subgroup analysis of patients without chronic kidney disease showed significantly lower fractional excretion of UA in the early-onset group [4.5％(3.3％,6.1％) vs.6.7％ (5.1％,8.7％),P＜0.05].Logistic regression analysis showed that obesity (OR=3.25) and fractional excretion of UA less than 7％ (OR=9.01,all P＜0.05) were risk factors of gout early onset.Conclusion The gout patients with early-onset younger than 30 present high serum and glomerular load of uric acid which might be due to obesity and relative under-excretion of renal uric acid.
ABSTRACT
Objective To study the correlation between fractional excretion of uric acid (FEUA) and blood uric acid,body mass index (BMI),blood pressure,blood glucose,blood lipid and other metabolic factors in patients with primary gout.Methods Sixty-two patients with primary gout (gout group) and 32 healthy people (control group) were selected in this study.Gout group was divided into uric acid excretion decreasing group (FEUA ＜ 7％,29 cases),mixed group (7％ ≤FEUA ≤ 12％,25 cases) and uric acid production increasing group (FEUA ＞ 12％,8 cases) according to the level of FEUA.The fasting blood glucose (FPG),2-hour postprandial blood glucose (2 h PBG),blood lipid,serum creatinine,blood uric acid,glycosylated hemoglobin were tested.24 hours urine was collected and urinary uric acid and urinary creatinine was measured,FEUA was calculated and analyzed.Results BMI,mean arterial pressure,blood uric acid,glycosylated hemoglobin,total cholesterol,2 h PBG in gout group was higher than that in control group,and high density lipoprotein cholesterol,FEUA was lower than that in control group,and there was significant difference (P ＜ 0.05).There was no significant difference in age,FPG,low density lipoprotein cholesterol,triacylglycerol between two groups (P＞ 0.05).There was no significant difference in age,blood uric acid,FPG,2 h PBG,glycosylated hemoglobin,total cholesterol,low density lipoprotein cholesterol,high density hpoprotein cholesterol among uric acid excretion decreasing group,mixed group and uric acid production increasing group (P ＞ 0.05),and there was significant difference in BMI,mean arterial pressure,triacylglycerol,FEUA among three groups(P＜ 0.05).FEUA was negatively correlated with blood uric acid in control group and gout group (r =-3.900,-0.476,P ＜0.05).FEUA was positively correlated with 24 h urinary uric acid in gout group (r =0.465,P =0.001),and nagatively correlated with triacylglycerol (r =-0.304,P ＜ 0.05).Pearson analysis showed that FEUA was negatively correlated with blood uric acid in uric acid excretion decreasing group (FEUA ＜ 7％) (r =-0.392,P ＜ 0.05),FEUA was positively correlated with blood uric acid in non uric acid excretion decreasing group (FEUA ≥7％)(r =0.437,P ＜ 0.05),but 24 h urinary uric acid was not correlated with blood uric acid(P ＞ 0.05).Multi-stepwise regression analysis showed that blood uric acid,glycosylated hemoglobin,FEUA was significantly correlated with the onset of the gout (P ＜ 0.05).Conclusions Besides blood uric acid level,there are significant changes in primary gout in blood pressure,serum glucose and lipid levels.FEUA could be used to estimate the ability of renal excrete the uric acid.Mean arterial pressure,glycosylated hemoglobin and FEUA are the risk factors for gout.
ABSTRACT
Introducción: La hiponatremia es el trastorno hidroelectrolítico más común entre pacientes internados. Conocer de manera precoz el estado del líquido extracelular (LEC) para el estudio de las causas de hiponatremia y su posterior tratamiento es de suma importancia. Se ha planteado la posibilidad de utilizar la excreción fraccional de ácido úrico (EFAU) como herramienta complemetaria para discernir LEC normal de LEC disminuído, incluso en pacientes bajo tratamiento diurético. Métodos: Se evaluaron en 45 pacientes seleccionados en forma prospectiva, parámetros clínicos y de laboratorio habituales al momento del diagnóstico de hiponatremia, para definir el estado del LEC. Una vez definido éste, se calculó la EFAU. Resultados: Se observó que en los 21 pacientes que conformaron el grupo de LEC disminuido, la tensión arterial, la natriuria, la excreción fraccional de sodio, la excreción fraccional de urea y la EFAU fueron significativamente menores (p < 0.05) que en los 24 pacientes del grupo LEC normal. Dentro de estas variables, la EFAU fue la de mayor sensibilidad y especificidad para predecir LEC disminuido, con un valor de corte < 10.9 %. Dentro del subgrupo de 15 pacientes que recibían diuréticos, la EFAU < 10.9 % tuvo una sensibilidad de 100% y una especificidad de 100% para predecir LEC disminuido. Conclusión: Así, la EFAU debería instaurarse dentro del protocolo de estudio de un paciente con hiponatremia, dado que, realizada con muestra aislada de sangre y orina, es un método sencillo y eficaz para efectuar en la urgencia, sobre todo en pacientes con diuréticos.
Introduction: Hyponatremia is the most common hydroelectrolitic disorder in hospitalized patients. It is essential to acquire an early understanding of the extracellular liquid (ECL) status for the study of the causes of hyponatremia and its subsequent treatment. The possibility of using the fractional excretion of uric acid (FEUA) as a supplementary tool to distinguish normal ECL from reduced ECL has been considered, including patients undergoing diuretic treatment. Methods: The typical clinical and laboratory parameters were examined at the time of the diagnosis of hyponatremia in 45 patients prospectively selected, to define the status of ECL. Once defined, the FEUA was estimated. Results: For the 21 patients within the reduced ECL group, blood pressure, natriuria, fractional excretion of sodium, fractional excretion of urea and FEUA were significantly lower (p < 0.05) than for the 24 patients within the normal ECL group. Among these variables, the FEUA was the one which showed more sensitivity and specificity to predict a reduced ECL, with a cutoff value < 10.9 %. Within the of 15 patients on diuretic treatment, FEUA < 10.9 % had a 100% sensitivity and a 100% specificity to predict a reduced ECL. Conclusion: Therefore, the FEUA should be included in the study protocol of a patient with hyponatremia,since when performed in an isolated sample of blood andurine, it constitutes a simple and efficient method to be implemented under emergency situations, especially in patients receiving diuretics.