Hyperuricemia, endogenous

Etiology

Primary hyperuricemia

• Increased production of purine

1. Idiopathic
2. Specific enzyme defects (eg, Lesch-Nyhan syndrome, glycogen storage diseases)

• Decreased renal clearance of uric acid (idiopathic)

Secondary hyperuricemia

• Increased purine catabolism and turnover

1. Myeloproliferative disorders
2. Lymphoproliferative disorders
3. Carcinoma and sarcoma (disseminated)
4. Chronic hemolytic anemias
5. Cytotoxic drugs
6. Psoriasis

• Decreased renal clearance of uric acid

1. Intrinsic kidney disease
2. Functional impairment of tubular transport:

• Drug-induced (eg, thiazides, probenecid)
• Hyperlacticacidemia (eg, lactic acidosis, alcoholism)
• Hyperketoacidemia (eg, diabetic ketoacidosis, starvation)
• Diabetes insipidus (vasopressin-resistant)
• Bartter's syndrome