Avoiding Kidney Damage And Gout From High Urinary Uric Acid

As mentioned on http://www.mygoutdietfoods.com, amorphous (shapeless) crystals of uric acid can form within the renal tubules or within the renal pelvis if the concentration of uric acid and the pH of the fluid is appropriate. It should be stressed again that these crystals are different from the urate crystals (MSUM) which occur in interstitial tissues and joint or tissue fluid. If diagnosed and treated early, these uric acid crystals can be washed out of the tubule and renal function restored to normal.

This is achieved by altering both the concentration and pH of the tubular fluid, i.e. by alkalizing the fluid and by producing a large flow rate of dilute urine. The potential for reversing this type of kidney damage needs to be remembered if there is any sudden deterioration of renal function in a patient with a high urine uric acid.

The damage from blockage of a tubule tends to occur mainly within the collecting ducts, although occasionally it can occur in the renal pelvis or ureter. In either of these latter positions, the crystals may clump together to produce renal calculi or renal stones. In many cases these stones consist not of uric acid but of calcium oxalate. Thus, both uric acid as well as calcium oxalate calculi in the renal pelvis may be a hazard of a sustained high urinary uric acid concentration from any cause.

The risk factors for forming calcium oxalate calculi are not all understood, but the absence of certain solubilising factors seems to be important. However, the presence of other aggravating factors such as a high urinary uric acid concentration is also important. Uric acid calculi cannot be seen on X-rays, whereas calcium oxalate calculi are radio-opaque and can be seen on plain X-rays.
Thus, while crystals may block the tubules, calculi or stones may form within the renal pelvis, ureter or bladder, where they can cause their own problems of infection, obstruction, bleeding or pain. In each case, the risk of forming calculi is greatly reduced by the maintenance of a dilute, alkaline urine or by the administration of allopurinol.

The presence of uric acid crystals within a renal tubule has two effects. First, it may block the flow of tubular fluid along that tubule and this may stop the functioning of the renal unit or nephron. Second, the tubular lining cells may interact with the crystals, ingesting them and digesting and degrading them.

If this is incomplete the crystals may pass beneath the tubular lining cells and through the tubular basement membrane, where they may become a focus for the formation of urate (MSUM) crystals within the tissue between the renal tubules, resulting in the formation of renal microtophi.

It is better to prevent the formation of uric acid crystals. The maintenance of a dilute urine is desirable for any patient with a uric acid problem. However, if this is insufficient, the administration of allopurinol will greatly reduce the risk of complications from a high urinary uric acid. It should be stressed that renal tubular damage from uric acid crystal obstruction may be reversible and the tubular cells may recover after appropriate treatment.

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