eMedicine Specialties > Nephrology > Acid-Base, Fluid, and Electrolyte Disorders

Hyperuricemia: Follow-up

Author: Yasir Qazi, MD, Assistant Professor of Medicine, Division of Nephrology, University of Southern California at Keck School of Medicine
Coauthor(s): James W Lohr, MD, Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo
Contributor Information and Disclosures

Updated: Sep 29, 2009

Follow-up

Further Inpatient Care

  • Patients with hyperuricemia generally do not require inpatient care. Typically, only patients with acute uric acid nephropathy require inpatient treatment.

Further Outpatient Care

  • For patients with symptomatic hyperuricemia, provide regular follow-up evaluations with serum uric acid level determinations.
  • For patients with gout, attempt to maintain uric acid levels below 6 mg/dL.
  • For patients with a history of uric acid nephrolithiasis, provide follow-up determinations of 24-hour urine excretion of uric acid to ensure that therapy has helped lower the excretion into the reference range.

Transfer

  • Patients with acute urate nephropathy and acute renal failure require transfer to a facility with dialysis.

Deterrence/Prevention

  • Hyperuricemia can often be prevented by reducing purines in the diet.

Complications

  • Gout
  • Acute uric acid nephropathy
  • Uric acid nephrolithiasis
  • Chronic renal insufficiency

Patient Education

  • Dietary education is important for patients with hyperuricemia.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the cause of hyperuricemia in patients with hereditary disorders of purine metabolism
  • Failure to recognize a condition such as septic arthritis and instead mistaking it for an acute attack of gout: When any doubt exists, perform joint aspiration to help rule out an infectious cause of arthritis.
  • Failure to pretreat a patient with a hematologic malignancy with allopurinol prior to initiation of chemotherapy: This can result in acute urate nephropathy.
  • Failure to recognize the development of a serious vasculitic hypersensitivity reaction to allopurinol in a patient being treated for asymptomatic hyperuricemia: This is a potential pitfall because of the broad consensus against such therapy.
 


More on Hyperuricemia

Overview: Hyperuricemia
Differential Diagnoses & Workup: Hyperuricemia
Treatment & Medication: Hyperuricemia
Follow-up: Hyperuricemia
References
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References

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  3. Dalbeth N, Merriman T. Crystal ball gazing: new therapeutic targets for hyperuricaemia and gout. Rheumatology (Oxford). Mar 2009;48(3):222-6. [Medline].

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  5. [Best Evidence] Kim SY, Guevara JP, Kim KM, et al. Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum. Jul 15 2009;61(7):885-92. [Medline].

  6. Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. Dec 8 2005;353(23):2450-61. [Medline].

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Further Reading

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Keywords

gout, nephrolithiasis, uric acid, uric acid overproduction, uric acid underexcretion, uric acid under-excretion, renal insufficiency, renal failure, diuretic therapy, diabetes insipidus, diabetic ketoacidosis, ethanol intoxication, salicylate intoxication, starvation ketosis, Lesch-Nyhan syndrome, Kelley-Seegmiller syndrome, leukemia blast crisis, rhabdomyolysis, cytotoxic therapy, ethanol consumption, familial juvenile gouty nephropathy, FJGN, medullary cystic disease, chronic lead nephropathy, syndrome X, hypertension, preeclampsia, eclampsia, hyperparathyroidism, sarcoidosis, lead intoxication, lead poisoning, lead toxicity, lead exposure, occupational lead exposure, moonshine consumption, trisomy 21, purine-rich diet, tumor lysis syndrome, deficiency of aldolase B, aldolase B deficiency, glucose-6-phosphatase deficiency, G-6-P deficiency, glycogen storage disease, GSD, glycogenosis type I, von Gierke disease

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Contributor Information and Disclosures

Author

Yasir Qazi, MD, Assistant Professor of Medicine, Division of Nephrology, University of Southern California at Keck School of Medicine
Yasir Qazi, MD is a member of the following medical societies: American Society of Nephrology
Disclosure: Nothing to disclose.

Coauthor(s)

James W Lohr, MD, Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo
James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Medical Editor

James H Sondheimer, MD, Director of Hemodialysis Unit, Harper Hospital; Associate Professor, Department of Internal Medicine, Division of Nephrology, Wayne State University School of Medicine
James H Sondheimer, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

George R Aronoff, MD, Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine
George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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