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August 1983

Hypouricemia and Renal Tubular Urate Secretion-Reply

Arch Intern Med. 1983;143(8):1634. doi:10.1001/archinte.1983.00350080155042

In Reply.  —Sanz et al presented an interesting combination of recurrent nephrolithiasis and hypouricemia probably due to increased uric acid secretion.During the past two years, I have encountered five patients with hyperuricosuria due to enhanced uric acid excretion. Three patients had persistent hypouricemia due to an increment in renal tubular urate secretion (of whom two were described in the October Archives). They showed abnormal oral glucose tolerance test results and two of them required treatment for diabetes. The remaining two patients had a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). When their serum sodium levels were decreased, their serum uric acid level fell and excretion of uric acid increased.Pyrazinamide and probenecid therapy was administered and the results were compatible with an increment in renal tubular urate secretion. In diabetes, as well as in SIADH, increased uric acid excretion brings about the lower serum uric acid level.1-5

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