Abstract
The role of the kidney in the maintenance of urate homeostasis is reviewed, with particular emphasis upon the major contributions of Dr. Alexander B. Gutman to our understanding in this area. Data in support of various models of renal urate transport are presented, in conjunction with a discussion of the pyrazinamide suppression test and its limitations as a means of characterizing urate transport. It is proposed that postsecretory reabsorption of urate, as well as the rate of urate secretion, controls and modulates the final rate of urate excretion in man. The renal basis for some of the disturbances of urate homeostasis encountered clinically is also considered. The role of the kidney in the pathogenesis of the hyperuricemia observed in hypertension, toxemia of pregnancy, gout and renal failure is discussed, as well as three apparently distinct defects in tubular reabsorption of urate which lead to hypouricemia. It is emphasized that the mechanisms of renal urate handling in health, and the pathogenesis of the disordered states of renal urate homeostasis which are discussed, remain partially within the realm of speculation. A clearer understanding of the pathophysiologic mechanisms underlying disordered urate balance awaits more complete knowledge of normal physiology.
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