Hyperuricemia in Starvation. ∗

Recent epidemiologic studies have revealed a striking correlation between obesity and hyperuricemia ( 1 , 2 ). This propensity of the obese is accentuated by starvation 2 . Previous reports implicate a decrease in renal clearance of uric acid, but the mechanism of this decline has not been clarified( 3 4 5 ). We have investigated this phenomenon in more detail and have determined the ratio of uric acid clearance to creatinine clearance as well as the influence of supplemental urea and potassium on the renal handling of uric acid.

Materials and Method. Eleven obese patients, 16 to 51 years of age, were selected from volunteers seeking assistance in weight reduction. Nine patients were female and 2 male. They were hospitalized throughout the study on the Metabolic Research Ward of the Bronx Municipal Hospital Center.

One male patient had clinically overt maturity onset diabetes previously requiring insulin therapy, but presently receiving tolbutamide, three grams daily. Although glycosuria persisted, therapy was withheld during hospitalization. A second patient had subclinical diabetes mellitus. Another patient had idiopathic hypoparathyroidism, adequately controlled by treatment with calcium gluconate and vit D. There was no evidence of other endocrinopathy, nor other intercurrent disease; no medications, other than daily multi-vitamin capsules and occasional sedatives were administered during the study.

Each patient fasted for 3 weeks during this time having free access to water. Three patients underwent simple fast for 3 weeks. Two patients were given 40 mEq potassium as K-triplex or KCl daily during the 3-week study; 2 patients received the same quantity of potassium plus 40 to 50 g of crystalline urea daily; and 4 patients received 40 to 50 g of urea daily.

All chemical analyses were carried out on the Technicon AutoAnalyzer (Technicon Instruments Corp., Chauncey, N.Y.). Uric acid was determined by a modification of the method of Henry, Sobel and Kim 6 ; creatinine was determined by a modification of the alkaline picrate method 7 ; sodium and potassium were measured by flame photometry (we would like to thank Dr. Eli Seifter for carrying out the chemical determinations).