Influence of the kidney upon urate homeostasis in health and disease

defects of primary hyperuricemia

Gout

and gout. Am J Med

Milestones in the treatment

Hyperuricemia

of gout. Am J Med 56: 676-685,

Arthritis

1974.

Several milestones have marked the progress in the treatment of gout in the past quarter of a century. Our aims now are to understand more of the genesis of hyperuricemia, to prevent the development of symptomatic gout, to avoid its possible complications and to treat its associated diseases when present.

Yu TF:

Gout

This is a review of the metabolic defects of primary gout, with major emphasis upon two well characterized, afthough uncommon, variants due to specific enzyme abnormaliiies: (1) structural mutants of phosphoribosylpyrophosphate (PP-ribose-P) synthetase with increased activities, resufting in increased rates of synthesis of PP-ribose-P, a key substrate of purine biosynthesis, and (2) structural mutants of hypoxanthineguanine phosphoribosyltransferase (HGPBT) with reduced activities resulting in reduced consumption of PP-ribose-P and therefore a surplus in the amount avaihble for purine biosynthesis de novo. The present state of our limited knowledge of control of purine biosynthesis is also reviewed briefly, and the potential mechanisms of excessive uric acid production in idiopathic primary gout is discussed.

JB: Metabolic 1974.

Uric acid

Purine biosynthesis

storage disease

Wyngaarden 56: 651664,

Glycogen

Hyperuricemia Kidney

Pyrazinamide

test

Renal urate transport

suppression

in health

FJ:

Peer review

publication

in biomedical

Biomedical

publication.

systems Am J Med 56: 686-692,

Reviewing

The conventional reviewing system of American biomedical journals determines where and when an author may publish, and hence may affect his career. Yet the system’s effectiveness in validating reports, or the cost of such validation, has been little studied. The author discusses the problems involved and concludes that, despite its deficiencies, the reviewing system is important to maintain standards. lt could be improved if studies of its operation were carried out, if reviewers were better indoctrinated, if the work load of reviewers were lessened, if reviews were signed, and if the reviewing process was more rewarding to reviewers.

lngelfinger 1974.

Peer review

The role of the kidney in the maintenance of urate homeostasis is reviewed, with particular emphasis upon the major contributions of Dr. Alexander B. Gutman to our understanding in this area. Data in support of various nodels of renal urate transport are presented, in conjunction with a discussion of the pyrazinamide suppression test and its limitations as a means of characterizing urate transport. The renal basis for some of the disturbances of urate homeostasis encountered clinically is also considered. The role of the kiiney in the pathogenesis of the hyperuricemia observed in hypertension, toxemia of pregnancy, gout and renal failure is discussed, as well as three apparently distinct defects in tubular reabsorption of urate which lead to hypouricemia.

Rieselbach RE, Steele TH: Influence of the kidney upon urate homeostasis and disease. Am J Med 56: 665-675. 1974.

Urate homeostasis

Hyperuricemia