Abstract
The occurrence of hyperuricemia in hyperparathyroidism 2–4 hypophosphatemia in certain cases of gout, 1 hypercalciuria, phosphaturia and uricosuria in Wilson's disease 6 and the simultaneous existence of both gout and hyperparathyroidism in the same patient, 4,8,9 suggests that calcium, phosphorus and uric acid might have relationships in common in their renal tubular transport mechanisms. If a common mechanism exists, it might be elucidated by experimentally altering metabolic handling of calcium and/or phosphorus and observing any resulting changes in uric acid metabolism. Three sets of experiments were done to test this possibility. (1) Eight normal volunteers were subjected to dietary depletion of calcium and phosphorus for 2 weeks and renal clearance studies done during the depletion period; (2) after 12 days of a calcium and phosphorus depletion diet, 6 normal subjects were infused with calcium and renal clearances done before and after; (3) after 10 days on a purine free diet 7 gouty patients were infused with calcium and renal clearances done before and after. Renal clearances for uric acid, phosphorus, calcium and endogenous creatinine were done on all subjects. Normal subjects on calcium and phosphorus depletion diets showed significant fall in clearances of both calcium and uric acid but no significant change in phosphorus clearance. Normal subjects on calcium and phosphorus depletion diet plus calcium infusion did not show the expected decrease in phosphorus clearance on hypercalcemic stimulation (suppression parathormone action); nor were uric acid clearances or serum uric acid concentrations affected. Patients with gout who had calcium infusion showed the normal decrease in phosphorus clearance after hypercalcemia but no change in uric acid clearance. It is concluded that calcium and phosphorus depletion and acute hypercalcemia do not influence uric acid clearance; hypercalcemia in gouty patients results in decrease in phosphorus clearance but does not affect uric acid clearance concomitantly. The evidence supports the concept that phosphorus, calcium and uric acid are not interrelated in their renal transport mechanisms.
Published Version
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