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synergy · 1
High urate and the cluster of problems in metabolic syndrome (high blood glucose, abnormal blood lipids, high blood pressure, abdominal obesity, fatty liver) often occur together; each is a risk factor for the other, and the mechanisms run in both directions rather than one simply causing the other.
regulates · 3
When the liver breaks down fructose it uses up ATP quickly, and the breakdown products end up as uric acid, so large amounts of fructose push blood urate up. In two large cohorts, people who drank more sugary drinks had a higher risk of gout (an observed association); by the mechanism, fructose is the pathway connecting the two.
Uric acid stones make up only a small share of kidney stones and behave differently from common calcium oxalate stones: they crystallize when urine pH is below 5.5 and barely show up on a plain X-ray. So in someone with flank pain and blood in the urine but a normal X-ray, think of them; a CT scan shows them clearly.
Estrogen helps the kidneys clear uric acid, which is why women before menopause generally have lower blood urate than men; after menopause the gap closes quickly, and the same person's risk takes a turn in those few years.
contrast · 1
High uric acid on a lab report is not gout: high blood urate by itself causes almost no symptoms, and most people with it never have an attack. Among adults in China, about 13% have high urate and about 1% have gout. Treating it as gout on the way, with strict food restrictions and repeated clinic visits, is the most common overreaction.