Renal parenchymal damage and dysfunction associated with disordered uric acid metabolism. Several syndromes can present.

• Gout: Acute urate crystal-induced arthritis related to chronic hyperuricemia due to uric acid renal underexcretion in 80–90% and uric acid overproduction in 10–20%
• Hyperuricemic acute renal failure: Precipitated by distal tubular obstruction resulting from acute massive overproduction of uric acid due to cell lysis. Serum uric acid usually greater than 15–20 mg/dL (0.88–1.18 mmol/L)
• Uric acid nephrolithiasis: Most commonly seen in gouty patients who are uric acid overproducers and have hyperuricosuria. Frequency of stone formation increases with increasing serum uric acid levels and urinary uric acid excretion rates. About 22% of gouty patients will form uric acid stones
• Hyperuricemia of chronic renal failure: Occurs when creatinine clearance is less than 15. Serum uric acid usually greater than 10 mg/dL. Secondary gout rare. Acute deterioration of renal function can be precipitated by an abrupt rise in serum uric acid
• Chronic urate nephropathy: Renal insufficiency attributed to parenchymal damage secondary to medullary urate deposition. Bulk of evidence supports conclusion that typical gout or asymptomatic hyperuricemia are unlikely to lead to serious renal insufficiency. In patients with gout, renal insufficiency can usually be attributed to a complicating medical condition, most often hypertension, diabetes, renal vascular disease, obstructive uropathy, urinary tract infection, or lead intoxication
• System(s) affected: Renal/Urologic
• Genetics: N/A
• Incidence/Prevalence in USA: Gout 0.3%, Hyperuricemia 5-10%
• Predominant age: Adults
• Predominant sex: Male > Female

• Hyperuricemic acute renal failure
  • Precipitated by chemotherapy for leukemia or lymphoma
  • Precipitated by heat stress and exercise
  • Oliguria
  • Anuria
  • Anorexia, nausea, vomiting, encephalopathy and other manifestations of uremia
  • Hypertension
  • Anemia
  • Dehydration
• Uric acid nephrolithiasis
  • Flank pain
  • Groin pain
  • Micro or gross hematuria
  • Anorexia
  • Nausea
  • Vomiting
  • Dehydration
• Hyperuricemia of chronic renal failure
  • Established chronic renal failure with glomerular filtration rate (GFR) less than 15–20
  • Serum uric acid greater than 10 mg/dL chronically
  • Intercurrent cause of abrupt increase in serum uric acid
  • Acute decrease in GFR
  • Acute onset of uremic symptoms

• Primary
  • Congenital gout, hypertension and hyperuricemia (autosomal dominant)
  • Congenital HGPRT deficiency (X-linked recessive)
  • Congenital PRPP overactivity (X-linked recessive)
  • Congenital glycogen storage disease, type I
• Secondary
  • Lead intoxication
  • Diuretics
  • Cytotoxic chemotherapy in leukemia or lymphoma
  • Heat stress and exercise
  • Diabetic ketoacidosis
  • Starvation ketosis
  • Chronic myeloproliferative disease
  • Psoriasis

• Sudden increase in uric acid load
• Dehydration
• Urine pH less than 5
• Hypertension
• Diabetes mellitus
• Renal insufficiency
• Renal vascular disease