Long-term consequences of hyperuricemia mainly gouty arthritis and kidney damage. Kidney damage after joint disease. Joints often obvious symptoms, and kidney disease is insidious , gout repeated more than 10 years the performance side has kidney damage . Acute hyperuricemia nephropathy mainly acute renal failure .
1 , chronic hyperuricemia nephropathy was acute gouty arthritis , aggravated at night . Often due to mental stress, fatigue, feast, alcoholism and infection -induced . Minor trauma such as surgery can also be induced . Metatarsophalangeal joints in the affected joint as much, followed by the ankle , hand, wrist , knee , etc. Especially in the first metatarsophalangeal joint is most common. Joint pain began to appear after a few hours hypersensitivity and significant redness, swelling, heat, pain . Shoulder, hip and other large joints less involved , but once involved often exudate . Progress with the disease , the deposition of urate in the joints gradually increased after the onset of frequent joint hypertrophy , fibrosis , with joint deformity, stiffness resulting in limited mobility .
Hyperuricemia change nephrotic urine mainly mild proteinuria and a small amount of red blood cells in urine . The early changes in renal function is concentrated function decline , and then gradually affecting glomerular filtration rate . When there is high blood pressure , atherosclerosis , diabetes, renal cysts and amyloid lesions exist, renal failure may occur , but also the fate of gouty nephropathy . Foreign reports gout and hypertension was 40%, the domestic is 63,1 % . Because 25% to 35 % of primary hypertension associated with hyperuricemia, so Hyperuricemia is a risk factor for cardiovascular disease . Hyperuricemia is often accompanied by high blood pressure , obesity and other risk factors of atherosclerosis prone to cause coronary heart disease, may also be urate crystal deposition in the arterial wall and intimal injury related .
2 , acute renal hyperuricemia
Leukemia, lymphoma and other myeloproliferative disorders and malignant tumors are widely disseminated , especially when treated with radiotherapy and chemotherapy, when a large number of hyperuricemia to renal excretion of uric acid , the uric acid crystals in the renal tubules , collecting ducts and renal pelvis abrupt deposition , causing tubular intraluminal pressure increased glomerular capsule pressure increased , resulting in a sharp decline in glomerular filtration rate . The clinical features of early excretion of uric acid increased , how -shaped crystals in urine , hematuria , and a small amount of proteinuria. Lesions progress oliguria and anuria, may be associated with low back pain , nausea , vomiting and lethargy uremia . Hyperuricemia acute uric acid nephropathy and uric acid were significantly increased . Reports in the literature of serum uric acid > 1189μmol / L (20mg/dl) accounted for 60% ; while only 14% of primary gout ; 20% of patients 24h urinary uric acid excretion > 19,48 μmol / L, while only 6 primary gout % .
3 , urate stones 10% to 25% of gout patients have kidney stones , often 200 times higher than the normal population . 1000mg daily uric acid excretion by approximately 20% with stone disease, such as when the discharge 1100mg half stones . Similarly urate stones and hyperuricemia , uric acid 1,37 μmol / L, then 50% of kidney stones. There are a number of diseases not associated with hyperuricemia and excess uric acid excretion , but because of less urine , urine can occur with high uric acid stones . As for ileostomy diarrhea , prostate disease in elderly patients , because of difficulties in urinating and drinking reduced , causing less urine , pH is low, uric acid stones may also occur.
Urate stones in the urinary tract symptoms are local irritation , urinary obstruction and secondary infection. These symptoms are due to stone size , shape , location and presence or absence of infection varies . Urate stones were round or oval , smooth or slightly rough, yellowish brown , solid texture . Renal colic tips obstruction. Few patients have bilateral renal colic ( ie kidney - kidney reflex ) , hematuria after the event , the row of stone . Manifestations of dysuria, urinary flow interrupt and even sudden anuria ( calculus anuria ) . Small stones are available from the urine. Approximately 80% of patients with gout not urate stones . Pure uric acid stones are translucent , usually can not be developed. But more than 2cm in diameter may be calcium oxalate and calcium phosphate stones and other mixed stones , and can be developed. Upper urinary tract calculi make huge renal pelvis deformation.
