Gout Food List
Various genetic defects in PRPP synthetase (reaction 1, Figure 34-2) present clinically as gout. Each defect eg, an elevated Vmax, increased affinity for ribose 5-phosphate, or resistance to feedback inhibition results in overproduction and overexcretion of purine catabo-lites. When serum urate levels exceed the solubility limit, sodium urate crystalizes in soft tissues and joints and causes an inflammatory reaction, gouty arthritis. However, most cases of gout reflect abnormalities in renal handling of uric acid. Figure 34-8. Formation of uric acid from purine nucleosides by way of the purine bases hypoxanthine, xanthine, and guanine. Purine deoxyribonucleosides are degraded by the same catabolic pathway and enzymes, all of which exist in the mucosa of the mammalian gastrointestinal tract. Uric acid Uric acid
Gout is an abnormality of uric acid metabolism resulting in hyperuricaemia and urate crystal deposition. Urate crystals deposit in joints acute gouty arthritis Four typical stages of gout are recognised Stage 1 acute gouty arthritis Stage 3 intercritical gout (intervals between attacks) chronic tophaceous gout and chronic gouty arthritis Asymptomatic hyperuricaemia 10 times more common than gout 7 elevated serum uric acid ( 0.42 mmol L in men, 0.36 mmol L in women) Typical clinical features of gout Fig. 31.7 Gout possible joint distribution Fig. 31.7 Gout possible joint distribution Nodular gout elevated serum uric acid (up to 30 can be within normal limits with a true acute attack) 13 synovial fluid aspirate typical uric acid crystals using compensated polarised microscopy this should be tried first as it is the only real diagnostic feature corticosteroids intra-articular following aspiration and culture (gout and sepsis can occur together) a digital anaesthetic block is advisable....
In a very limited number of experimentally-induced models of cell death, GRP94 is released during necrotic, but not apoptotic, cell death (Basu et al., 2000 Berwin et al., 2001). These findings are of particular interest to the Danger Model (Matzinger, 2002), and the molecular identification of pathological cell death-derived molecular signals, such as uric acid and lysophosphatidyl choline (lyso-PC) (Lauber et al., 2003 Shi et al., 2003). Uric acid and lyso-PC have been shown to stimulate macrophage migration and the activation of macrophage pro-inflammatory responses (Lauber et al., 2003 Shi et al., 2003). However, there is controversy as to whether apoptotic cells themselves, though through different signals, are also capable of eliciting an inflammatory response (Gallucci and Matzinger, 2001 Ip and Lau, 2004).
Different animals excrete excess nitrogen as ammonia, uric acid, or urea. The aqueous environment of teleostean fish, which are ammonotelic (excrete ammonia), compels them to excrete water continuously, facilitating excretion of highly toxic ammonia. Birds, which must conserve water and maintain low weight, are uri-cotelic and excrete uric acid as semisolid guano. Many
Human tissues can synthesize purines and pyrimidines from amphibolic intermediates. Ingested nucleic acids and nucleotides, which therefore are dietarily nonessen-tial, are degraded in the intestinal tract to mononucleotides, which may be absorbed or converted to purine and pyrimidine bases. The purine bases are then oxidized to uric acid, which may be absorbed and excreted in the urine. While little or no dietary purine or pyrimidine is incorporated into tissue nucleic acids, injected compounds are incorporated. The incorporation of injected 3H thymidine into newly synthesized DNA thus is used to measure the rate of DNA synthesis.
Calculi (kidney stones). (A) Photograph of calcium oxalate calculi shows that these kidney stones are colorless, octahedral-shaped crystals that look like small squares crossed by intersecting diagonal lines. These are the most common (80 ) type of kidney stone. (B) Photograph of magnesium ammonium sulfate (struvite or triple phosphate) calculi shows that these kidney stones are colorless, rectangular, prism-shaped crystals. These are the second most common (15 ) type of kidney stone. (C) Photograph of uric acid calculi shows that these kidney stones are yellow or red-brown, diamond or rhombic prism-shaped crystals. These are the third most common (5 ) type of kidney stone. (D) Photograph of cystine calculi shows that these kidney stones are colorless, refractive, and hexagonal-shaped crystals. These are the least common (1 ) type of kidney stone. (A D reprinted with permission from Graff L A Handbook of Routine Urinalysis. Philadelphia, JB Lippincott, 1983, pp 93, 144,...
Many species are of economic importance as agricultural pests. Some, such as the European starling, occur in such numbers in cities that the uric acid from their droppings damages buildings and monuments. Some are considered hazardous to human health because of their large roosting congregations near or in human cities. Many help control insect pests others help maintain forest tree-species diversity
Xanthine oxidase, in turn, promotes the catabolism of xanthine and hypoxanthine to uric acid, yielding oxygen free radicals in the process (84). We have recently shown that MA treatment increases the concentration of uric acid in the striatum, providing evidence that glutamate-mediated excitotoxic stress accompanies MA administration (85).
Synthetic analogs of purines, pyrimidines, nucleosides, and nucleotides altered in either the heterocyclic ring or the sugar moiety have numerous applications in clinical medicine. Their toxic effects reflect either inhibition of enzymes essential for nucleic acid synthesis or their incorporation into nucleic acids with resulting disruption of base-pairing. Oncologists employ 5-fluoro- or 5-iodouracil, 3-deoxyuridine, 6-thioguanine and 6-mer-captopurine, 5- or 6-azauridine, 5- or 6-azacytidine, and 8-azaguanine (Figure 33-12), which are incorporated into DNA prior to cell division. The purine analog allopurinol, used in treatment of hyperuricemia and gout, inhibits purine biosynthesis and xanthine oxidase activity. Cytarabine is used in chemotherapy of cancer. Finally, azathioprine, which is catabolized to 6-mercap-topurine, is employed during organ transplantation to suppress immunologic rejection.
PRV is frequently discovered incidentally when a complete blood count is performed for another reason. When symptoms are present, they are usually nonspecific. Fatigue, headache, and diaphoresis are common. Pruritis, often following a hot shower, is a frequent complaint. Up to 15 of patients may present with a thrombotic episode. Thrombotic cerebrovascular accidents, coronary artery thrombosis, Budd-Chiari syndrome, and pulmonary embolus all occur. Cavernous sinus thrombosis may also occur in untreated or poorly controlled disease. Erythromelalgia is specific to PRV and ET, and it is associated with an elevated platelet count and paradoxical vasodilation. It is characterized by redness, warmth, and a burning pain affecting the digits and responds promptly to aspirin. Gout may be a presenting manifestation of an MPD. There is an increased incidence of peptic ulcer disease in patients with PRV. Iron deficiency may occur and may initially mask the diagnosis. An elevated hematocrit with...
William Nyhan and his student Michael Lesch examined a seriously ill boy with a strange combination of symptoms. The boy had blood in his urine, high concentrations of uric acid in his blood, and uncontrollable spasms in his arms and legs. He was mentally retarded and self-destructively bit his fingers and lips. After carefully studying the boy, Nyhan and Lesch came to the conclusion that he was afflicted by an undescribed disease. Soon other patients with similar symptoms were reported, and the disease became known as the Lesch-Nyhan syndrome. One of the earliest symptoms of Lesche-Nyhan syndrome is the appearance of orange sand actually uric acid crystals in diapers a few weeks after birth. Within a year, the child begins to exhibit writhing movements of the hands and feet and involuntary spasms. About half of the children have seizures. After 2 or 3 years, some of the children exhibit compulsive self-mutilation biting fingers, lips, the tongue, and the insides of the...
Fixation the usual fixation for skin biopsies for histology is 10 formalin. Mast cells are easier to demonstrate if the skin biopsy has been fixed in alcohol. Where a mast cell lesion is suspected the biopsy should be divided and halves placed in formalin and alcohol. However, if mast cells are present in large numbers they can still be seen in formalin-fixed tissue. Similarly, the ureate crystals in gout dissolve in formalin. It is still possible to diagnose gout on formalin-fixed tissue but it is easier to demonstrate the crystals if the tissue has been placed in alcohol fixative.
Labs Serum electrolytes, calcium, phosphorus, creatinine, uric acid. Urine cystine, UA microscopic (hematuria), urine culture, KUB, intravenous pyelogram. PTH levels (if hypercalcemia), 24-hour urine calcium, phosphate, urate, oxalate, citrate, Cr, sodium, urea nitrogen, and cystine.
Other physical consequences include peptic ulcer, pancreatitis, gastritis, cardiomyopathy, myopathy, gout, vitamin deficiencies, drug interactions (the effect of psychotropic drugs may be either enhanced or reduced), and raised susceptibility to infections, including tuberculosis and malignancies.
Actions irreversibly inhibits platelet cyclo-oxygenase, inhibits the formation of platelet-aggregating substance thromboxane A2 platelet aggregation, acts on hypothalamus heat-regulating center to reduce fever. Indications treatment of mild to moderate pain, inflammation, and fever adjunctive treatment of Kawasaki disease used for prophylaxis of myocardial infarction and transient ischemic episodes. Dose (adult) analgesic and antipyretic 325-650 mg every 4-6 hours PO or rectal anti-inflammatory 2.4-5.4 g day PO in divided doses myocardial infarction prophylaxis 75-325 mg day PO. Dose (ped) analgesic and antipyretic 10-15 mg kg PO PR every 4-6 hours (up to 60-80 mg kg 24 hr) antiinflammatory 60-100 mg kg day PO divided every 6-8 hours Kawasaki disease 80-100 mg kg 24 hrs PO in 4 divided doses during febrile phase until defervesces, then decrease to 3-5 mg kg 24 hrs PO every am (continue for at least 8 weeks). Clearance primarily by hepatic microsomal enzymes. Adverse effects may cause...
The most common adverse event associated with patients receiving filgrastim relative to placebo-treated patients is bone pain (15-39 vs 0-21 ) (93). This dose-related adverse event appears to begin shortly after beginning treatment with filgrastim and may occur again or worsen just before neutrophilic recovery among patients who have previously received myelosuppressive chemotherapy (93). Both filgrastim and sargramostim can cause benign transient increases in serum concentrations of lactic dehydrogenase (LDH), alkaline phosphatase, and uric acid. Although the mechanisms of these increases are poorly understood, they are probably related to increased cell turnover in chemotherapy (94). The administration of sargramostim is associated with heightened activities of several cytokines (such as IL-1, IL-6, tumor necrosis factor-a, and leukotrienes), which may explain some of the asymmetry in that HGF's adverse event profile relative to that of filgrastim. In particular, the presence of...
The kidneys are highly vascular organs they receive approximately 25 of the cardiac output. The kidneys produce urine, initially an ultrafiltrate of the blood, which is then modified by selective resorption and specific secretion by the cells of the kidney. The final urine is conveyed by the ureters to the urinary bladder, where it is stored until discharged via the urethra. f The final urine contains water and electrolytes as well as waste products, such as urea, uric acid, and creatinine, and breakdown products of various substances.
As mentioned, lithium represents a common treatment for bipolar disorder. Lithium salts were first used therapeutically in the nineteenth century as remedies for sleeplessness and gout. Since the report of their efficacy in the treatment of bipolar disorder in the late 1940s by John Cade, lithium has been widely used in the treatment of acute manic symptoms and mood episode prophylaxis 21 . As mentioned, a number of double-blind studies have confirmed lithium's efficacy both in the acute treatment of mania, and for mania prophylaxis 14 . Further, multiple studies have suggested that lithium may be useful for both the acute and prophylactic treatment of depression (see 22 and 23 for meta-analysis and review). Unfortunately, many of the studies addressing monotherapy antidepressant effects had with some methodological shortcomings in particular, low sample sizes and the use of crossover study designs. In clinical experience, lithium's antidepressant effects as monotherapy may be modest,...
Coronary heart disease, estimated to be as high as 60 in some populations (McKeigue et al., 1993 Reaven, 1988). Since the original description of the Metabolic Syndrome, its component features have expanded to include microalbuminuria, central obesity, raised levels of plasminogen activator inhibitor-1 (PAI-1) and uric acid. Genetic associations have been shown in case-control studies, although many of these still require replication and mechanistic explanation. The most consistent of these associations is that of the peroxisome pro-liferator activated receptor (PPAR)-g polymorphism Pro12Ala with type 2 diabetes mellitus and insulin sensitivity. By analyzing over 3000 individuals, the authors found a modest (1.25-fold) but significant (P 0.002) increase in diabetes risk associated with the more common proline allele ( 85 o frequency). Because the risk allele occurs at such high frequency, its modest effect translates into a large population attributable risk, influencing as much as 25...
Ammonia readily diffuses across skin or gills, provided plenty of water is present, but is not efficiently excreted by the kidneys. Ammonia is highly toxic, and animals cannot survive if this substance accumulates in their bodies. Terrestrial organisms excrete nitrogenous waste in the form of urea or uric acid, which are less toxic and which require less water than does excretion of ammonia. Urea is the main nitrogenous waste in terrestrial amphibians, whereas uric acid (which requires very little water) is the main nitrogenous effluent in reptiles. Finally, some desert-dwelling reptiles have a remarkable ability to tolerate high plasma urea concentrations during drought. This characteristic allows the animals to minimize water loss that would be coincident with excretion. Rather than being excreted, nitrogenous waste is simply retained as urea, and water is conserved. When a rainfall finally occurs, reptiles (e.g., the desert tortoise Gopherus agassizii)...
GRP94 is acting an innate immune adjuvant than as a cross-presentation antigen. This conclusion is, however, far from established and is, as noted, controversial. An open question that remains is whether or not GRP94 elicits this activation alone or only in concert with other danger signals. Available data demonstrate that tumor-derived peptides are not per se required for function however, in these experiments, GRP94 was provided to the mouse in the presence of irradiated, i.e., dying cells. As such, cells would be expected to release many of the well characterized danger signals, including uric acid and lysophosphatidyl choline. The precise molecular basis for immune activation remains to be defined.
Lesch-Nyhan syndrome, an overproduction hyperuricemia characterized by frequent episodes of uric acid lithiasis and a bizarre syndrome of self-mutilation, reflects a defect in hypoxanthine-guanine phosphoribo-syl transferase, an enzyme of purine salvage (Figure 34-4). The accompanying rise in intracellular PRPP results in purine overproduction. Mutations that decrease or abolish hypoxanthine-guanine phosphoribosyltrans-ferase activity include deletions, frameshift mutations, base substitutions, and aberrant mRNA splicing.
Studies have sought an association between measured transport-related air pollution compounds and non-allergic respiratory morbidity. In the Netherlands, Steerenberg et al. (2001) compared children attending a school located near a busy motorway in Utrecht (mean black smoke levels 53 pg m3) with children in suburban areas attending a school located in the middle ofa green area (mean black smoke levels 18 pg m3). The former showed significantly higher mean levels of inflammatory nasal markers (interleukin-8 (IL-8 - +32 ), urea (+39 ), uric acid (+26 ), albumin (+15 ), nitric oxide metabolites (+21 )), as well as a slightly lower (although not significant) peak expiratory flow (-5.3 ml min). Associations of several inflammatory markers and peak expiratory flow with measured black smoke level were more pronounced in the urban than suburban children.
Dose-dependent, predictable, and spontaneously reversible increases in serum alkaline phosphatase, lactic dehydrogenase, and uric acid were reported. No serious clinical sequelae were reported in association with biochemistry abnormalities.
Renal function tests are often abnormal in preeclampsia. In normal pregnancies, the uric acid level declines during pregnancy and then returns to baseline by term. A uric acid level of greater than 5.0 mg per dL may indicate preeclampsia. Creatinine levels decrease from a normal of 1.0 to 1.5 mg per dL to 0.8 mg per dL or less throughout normal pregnancy but are increased in preeclampsia. Decreased renal perfusion may be indicated by the presence of creatinine levels at term that are the same as normal prepregnancy levels. H. Laboratory evaluation. The urine should be tested for protei n. A complete blood count with platelet count, urinalysis, creatinine level, uric acid, a 24-hour urine collection, creatinine clearance and liver function tests should be completed. A screen for early DIC, including fibrin-split products, prothrombin time and total fibrinogen, should be done.
To understand bat body adaptations for flight, it may be instructive to examine bird bodies. Bird bodies are designed for mass reduction. They do this in a number of ways. They have lost teeth and the accompanying heavy jaws and jaw musculature over evolutionary time. They have thin, hollow, and strong bones. Many bones are fused or reduced in size. The long bony tail of their ancestors has been greatly reduced to the small vestigial pygostyle. Birds have a series of air sacs in the body that serve to reduce weight. They do not have a urinary bladder to store urine nor do they have a urethra. The kidneys excrete uric acid into the cloaca where it is mixed with intestinal contents to produce the white guano associated with birds. Birds have lost one ovary, and lay eggs so they do not have to carry a fetus. The most distinctive feature of birds is their feathers, which provide lift, insulate them against heat or cold, streamline the body, and reduce mass.
Finally, a number of studies have looked at the physiological changes that occurred in survivors of natural disaster. For example, in a longitudinal study by Trevisan et al. (1997), factory workers* uric acid levels were measured on three occasions within 12 years. In between, a major earthquake interrupted the study, so that some of the participants were measured before, others after the quake. Those workers measured after the quake had signi cantly lower levels of serum uric acid than those examined before. Seven years later, workers who reported suffering from the aftermath of the quake had elevated levels of uric acid compared to unaffected individuals.
Free radical production is enhanced in both the ischemic core and penumbral following stroke injury, and this is believed to cause much of the damage seen in the core as well as penumbra. There are many agents that either block free radical production or inhibit its activation that have been shown to be very effective in experimental models. Uric acid is a well-known natural antioxidant present in fluids and tissues. Administration of uric acid resulted in a highly significant reduction in ischemic damage and improved behavioral outcome (Yu et al., 1998). Edaravone, Tetramethylpyrazine, alpha-phenyl-N-tert-butyl-nitrone, FR210575, and NXY-59 are other free radical inhibitors that were effective against experimental stroke injury. EGb-761 is a free radical scavenger derived from a concentrated extract of Ginkgo that is currently in a phase 2 clinical trial (Legos et al., 2002). Clinical trials with free radical scavengers have had limited success after acute ischemic stroke, but have...
The dark-field microscope is useful in examining au-toradiographs, in which the developed silver grains appear white in a dark background. Clinically, it is useful in examining urine for crystals, such as those of uric acid and oxalate, and in demonstrating spirochetes, particularly Treponema pallidum, the organism that causes syphilis, a sexually transmitted disease.
Eccrine sweat glands play a major role in temperature regulation through the cooling that results from evaporation of water from sweat on the body surface. The secretory portion of the glands produces a secretion similar in composition to an ultrafiltrate of blood. Resorption of some of the sodium and water in the duct results in the release of a hypotonic sweat at the skin surface. This hypotonic watery solution is low in protein and contains varying amounts of sodium chloride, urea, uric acid, and ammonia. Thus, the eccrine sweat gland also serves, in part, as an excretory organ.
A 35 year old Hispanic woman was brought to the ER because of acute chest pain and shortness of breath. Her medical history included hyperthyroidism treated for 4 years with PTU (propylthiouracil), tonsillectomy at 15 years of age, and cigarette smoking for the past 20 years. The patient described non-progressive dyspnea on exertion, and occasional episodes of chest pain and abdominal pain after each meal. She had not taken any medications recently. Upon arrival, her pulse was 120 ppm with diminished carotid and lower extremity pulses and absent pulses in the upper extremities. Her BP was 97 68 mmHg. There was central cyanosis. An ECG showed RBBB and ST elevation in the anterolateral leads. An arterial blood gas showed hypoxemia. The chest x ray was unremarkable (no cardiomegaly). Blood chemistries revealed slightly low albumin (normal total protein), calcium and uric acid slightly elevated LDH, SGPT, CK, alkaline phosphatase and creatinine, and normal bilirubin and SGOT. The...
Therapeutic Uses and Folklore horseradish was traditionally used by Europeans to treat gout, kidney stones, asthma, and bladder infections. It was used in Europe to prevent scurvy before vitamin C was discovered. Grated horseradish mixed into a paste is a home remedy for chest congestion and stiff muscles because it brings blood to the surface of the skin and warms the skin.
Both filgrastim and rHuGM-CSF have been safe and well tolerated in patients with hematologic toxicities. Medullary bone pain, reported in up to 24 of patients, was the only consistently observed adverse reaction attributed to filgrastim therapy. Mild-to-moderate spontaneously reversible increases in uric acid, lactate dehydrogenase, and alkaline phosphatase have been reported in filgrastim-treated patients (27-58 of patients) (38,65-72).
Therapeutic Uses and Folklore lemon verbena has been used traditionally by Europeans as a diuretic and a gout remedy, to treat inflammation of the liver or spleen, and even to aid depression. It is also brewed in tea as a home remedy to relieve colds and fevers. Lemon verbena is a natural insect repellent.
Specimens With Gouty Changes For the demonstration of deposits in gout or pseudogout, the murexide test is used. A sample of finely dispersed tissue fragments is heated with an equal volume of 25 nitric acid until the acid has evaporated. To the dry residue add 2-3 drops of 25 ammonium hydroxide solution and then the same amount of 20 sodium hydroxide solution. In the presence of urates, the dry residue will be bright red or orange, purple after addition of ammonium hydroxide, and blue-violet after addition of sodium hydroxide. For the preparation of museum specimens, the sample is dehydrated over 2 wk in several changes of absolute alcohol. Transfer into mounting fluid (see below). Deposits also can be displayed in their native state.
Microtubules are essential for vesicular transport (endocytosis and exocytosis) as well as cell motility. Certain drugs, such as colchicine, bind to tubulin molecules and prevent their polymerization this drug is useful in the treatment of acute attacks of gout, to prevent neutrophil migration and to lower their ability to respond to urate crystal deposits in the tissues. Vinblastine and vincristine represent another family of drugs that bind to microtubules and inhibit the formation of the mitotic spindle essential for cell division. These drugs are used as antimitotic and antiproliferative agents in cancer therapy. Another drug, Taxol, is used in chemotherapy for breast cancer. It stabilizes microtubules, preventing them from de-polymerizing (an action opposite to that of colchicine), thus arresting cancer cells in various stages of cell division.
Historical note Chamomiles have been used as medicines since antiquity and traditionally grouped in botanical texts under the same general heading. They were probably used interchangeably. Roman chamomile was reportedly used to embalm the Egyptian Pharaoh, Ramses II, and is thought to have been introduced into Britain bythe Romans during their conquests. The Anglo-Saxons used chamomile, presumably the Roman chamomile, as one of their nine sacred herbs. Culpeper lists numerous ailments for which chamomile was used, such as jaundice, fevers, kidney stones, colic, retention of urine and inflammation of the bowel (Culpeper 1 995). It was also widely used to treat common conditions in children including colic in infants, teething pains and fever (Grieve 1976). It is used in the treatment of gout and to reduce the severity of sciatic pain, either taken internally or applied as a poultice externally (Culpeper 1995). Today, chamomile tea is one of the most popular herbal teas in Australia and...
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