J Korean Med Sci.  2020 Apr;35(13):e95. 10.3346/jkms.2020.35.e95.

The Utility of the Random Urine Uric Acid-to-Creatinine Ratio for Patients with Gout Who Need Uricosuric Agents: Retrospective Cross-Sectional Study

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
  • 2Division of Nephrology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea.

Abstract

Background
The 24-hour uric acid excretion measurement is important in assessing disease status and helping to select the appropriate uric acid-lowering agent for patients with gout, however, it is inconvenient. The authors investigated the efficacy of the random urine uric acid-to-creatinine (UA/CR) ratio to screen the patients who under-secreted 24-hour urine uric acid.
Methods
This was a retrospective cross-sectional study. Ninety patients with gout, without undergoing uric acid-lowering treatment were enrolled. Twenty-four-hour urine and random urine samples were obtained on the same day. Six hundred mg of uric acid in the 24-hour urine sample was used as a standard for distinguishing between over and under-excretion groups.
Results
The random urinary UA/CR ratio showed positive correlation with 24-hour urine uric acid excretion (γ = 0.398, P < 0.001). All the patients with the random UA/CR less than 0.2 excreted less than 600 mg uric acid in 24-hour urine collection. When the random urine UA/CR ratio < 0.2 was regarded as a positive result, the positive predictive value, negative predictive value, sensitivity, and specificity in the uric acid under-excretion were 100% (8 of 8), 64.6% (53 of 82), 21.6% (8 of 37), and 100% (53 of 53), respectively.
Conclusion
There is a moderate positive correlation between the random urinary UA/CR ratio and 24-hour urine uric acid excretion, so that UA/CR ratio may not be a good predictor of 24-hour urine uric acid excretion. However, the random urine UA/CR ratio 0.2 can be a useful predictor to screen the gouty patients who need to be treated with uricosuric drugs.

Keyword

Urine; Uric Acid; Creatinine; Gout; Uricosuric Agents

Figure

  • Fig. 1 Receiver operation characteristic curves for the random urine uric acid-to-creatinine ratio to discriminate 24-hour urine uric acid excretion > 600 mg.

  • Fig. 2 The correlations between 24-hour urine uric acid excretion and the random urine UA/CR.UA/CR = uric acid-to-creatinine ratio.


Reference

1. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012; 64(10):1431–1446. PMID: 23024028.
Article
2. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017; 76(1):29–42. PMID: 27457514.
Article
3. Schumacher HR, Chen LX. Gout and other crystal-associated arthropathies. In : Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill Education;2015. p. 2234.
4. Perez-Ruiz F, Hernandez-Baldizon S, Herrero-Beites AM, Gonzalez-Gay MA. Risk factors associated with renal lithiasis during uricosuric treatment of hyperuricemia in patients with gout. Arthritis Care Res (Hoboken). 2010; 62(9):1299–1305. PMID: 20506124.
Article
5. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015; 67(10):2557–2568. PMID: 26352873.
Article
6. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999; 130(6):461–470. PMID: 10075613.
Article
7. Moriwaki Y, Yamamoto T, Takahashi S, Yamakita J, Tsutsumi Z, Hada T. Spot urine uric acid to creatinine ratio used in the estimation of uric acid excretion in primary gout. J Rheumatol. 2001; 28(6):1306–1310. PMID: 11409124.
8. Perez-Ruiz F, Calabozo M, Erauskin GG, Ruibal A, Herrero-Beites AM. Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output. Arthritis Rheum. 2002; 47(6):610–613. PMID: 12522834.
Article
9. Simkin PA, Hoover PL, Paxson CS, Wilson WF. Uric acid excretion: quantitative assessment from spot, midmorning serum and urine samples. Ann Intern Med. 1979; 91(1):44–47. PMID: 464453.
Article
10. Shojaei-Far Z, Razi F, Bandarian F, Rambod C, Qorbani M. A detailed comparison of morning and random urine specimen levels with 24 hour urinary excretion levels of seven biochemical parameters with a proposed formula. Ann Clin Lab Sci. 2017; 47(2):201–207. PMID: 28442523.
11. Rodby RA, Rohde RD, Sharon Z, Pohl MA, Bain RP, Lewis EJ, et al. The urine protein to creatinine ratio as a predictor of 24-hour urine protein excretion in type 1 diabetic patients with nephropathy. Am J Kidney Dis. 1995; 26(6):904–909. PMID: 7503064.
Article
12. Ruggenenti P, Gaspari F, Perna A, Remuzzi G. Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes. BMJ. 1998; 316(7130):504–509. PMID: 9501711.
Article
13. Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012; 367(1):20–29. PMID: 22762315.
Article
14. Rees F, Hui M, Doherty M. Optimizing current treatment of gout. Nat Rev Rheumatol. 2014; 10(5):271–283. PMID: 24614592.
Article
15. So A, Thorens B. Uric acid transport and disease. J Clin Invest. 2010; 120(6):1791–1799. PMID: 20516647.
Article
16. Maesaka JK, Fishbane S. Regulation of renal urate excretion: a critical review. Am J Kidney Dis. 1998; 32(6):917–933. PMID: 9856507.
Article
17. Enomoto A, Kimura H, Chairoungdua A, Shigeta Y, Jutabha P, Cha SH, et al. Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature. 2002; 417(6887):447–452. PMID: 12024214.
18. Miyazaki H, Sekine T, Endou H. The multispecific organic anion transporter family: properties and pharmacological significance. Trends Pharmacol Sci. 2004; 25(12):654–662. PMID: 15530644.
Article
19. Hamada T, Ichida K, Hosoyamada M, Mizuta E, Yanagihara K, Sonoyama K, et al. Uricosuric action of losartan via the inhibition of urate transporter 1 (URAT 1) in hypertensive patients. Am J Hypertens. 2008; 21(10):1157–1162. PMID: 18670416.
Article
20. Vahlensieck EW, Bach D, Hesse A. Circadian rhythm of lithogenic substances in the urine. Urol Res. 1982; 10(4):195–203. PMID: 7179612.
Article
21. Puig JG, Torres RJ, de Miguel E, Sánchez A, Bailén R, Banegas JR. Uric acid excretion in healthy subjects: a nomogram to assess the mechanisms underlying purine metabolic disorders. Metabolism. 2012; 61(4):512–518. PMID: 22001332.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr