Hyperuricemia, acute gout, renal insufficiency and urate nephrolithiasis due to starvation

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Abstract
The levels of uric acid in the serum and the excretion in the urine was measured in a group of 43 obese individuals who starved for prolonged periods and were then fed low calorie diets. Many obese patients were noted to have abnormally high serum uric acid levels initially. With starvation, marked hyperuricemia occurred due to impaired renal clearance. Four patients developed gout. Renal clearance was improved with the administration of probenecid and gout did not occur in the treated patients. The sudden excretion of large amounts of uric acid when hyperuricemic patients were given probenecid led to the development of uric acid calculi in one subject. Feeding of protein or carbohydrate resulted in a reduction of starvation ketosis and serum uric acid levels while improving renal uric acid clearance.