RENAL HANDLING OF URATE IN 2 PATIENTS WITH HYPERURICEMIA AND PRIMARY HYPERPARATHYROIDISM
RENAL HANDLING OF URATE IN 2 PATIENTS WITH HYPERURICEMIA AND PRIMARY HYPERPARATHYROIDISM
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DOI：
10.2169/internalmedicine.31.807
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发表时间：
1992-06-01
影响因子：
1.2
通讯作者：
MASHIBA, H
中科院分区：
文献类型：
--
作者：
HISATOME, I;ISHIMURA, M;MASHIBA, H
2例原发性甲状旁腺功能亢进患者由于尿酸清除率降低而出现高尿酸血症。在四组分模型系统分析中，尿酸盐的小管分泌通常减少，但滤过的尿酸盐和分泌前的尿酸盐重吸收都没有变化。两例患者的尿素清除率均有所降低，前者的甲状旁腺切除术和后者的生理盐水静脉输注均可降低血清尿酸水平，并增加尿酸清除率与肌酐清除率之比。令人感兴趣的是，血清尿酸水平较高的前一病例分泌后重吸收相对较高，即使尿管中尿酸的分泌减少。然而，血清尿酸水平较低的后一组患者分泌后尿酸再吸收的减少与肾小管分泌的减少成正比。这些结果表明，在原发性甲状旁腺功能亢进的高尿酸血症患者中，通常存在毛细血管网络灌注不足导致的小管尿酸分泌减少，然而，高尿酸血症的严重程度可能取决于分泌后尿酸再吸收的功能障碍。
Two patients with primary hyperparathyroidism had hyperuricemia due to the decrease in urate clearance. In analysis by 4-component model system, the tubular secretion of urate commonly decreased without changes in either filtered urate or presecretory reabsorption of urate. Both patients had a reduction of urea clearance, and both parathyroidectomy in the former case and intravenous infusion of saline in the latter case could reduce the serum urate level associated with the increase in the ratio of urate clearance to creatinine clearance. It is of interest that the former case with a higher serum urate level had a relatively higher postsecretory reabsorption, even with the decrease in tubular secretion of urate. However, the latter patient with a lower serum urate level had a decrease in postsecretory reabsorption of urate in proportion to the decrease in tubular secretion. These results suggest that in hyperuricemia patients with primary hyperparathyroidism, the reduction of tubular urate secretion via hypoperfusion of the capillary network is typically present, however, the severity of the hyperuricemia might be dependent on the dysfunction of the postsecretory reabsorption of urate.