Start

Consider secondary causes of hyperuricemia associated with elevated uric acid production

Treat

Routine medical management

Correct underlying cause if possible and/or appropriate

Hyperuricemic symptoms

Asymptomatic

End

Myeloproliferative diseases
Lymphoproliferative diseases
Hemolytic anemias
Polycythemia vera
Solid tumor malignancies
Psoriasis
Glycogen storage disease
Obesity
Ethanol
Fructose (large dose)
Tissue necrosis
Exercise
Convulsions
Drugs

Cytotoxic agents
B₁₂ (patients with pernicious anemia)
Pancreatic extract

Cytotoxic agents
B₁₂ (patients with pernicious anemia)
Pancreatic extract

Treat

Treat

Close follow-up of renal function

Routine medical management

Treat

Symptomatic

Asymptomatic

Routine medical management

Follow renal function closely

Routine medical management

Consider acquired causes of hyperuricemia associated with normal urinary acid excretion

Cause of hyperuricemia is not discernible

If positive and patient is asymptomatic and not in clinical setting for acute uric acid nephropathy

If positive and clinical setting for acute uric acid nephropathy: Myelo- or lymphoproliferative disorder, solid tumor with anticipated cytotoxic and/or radiation therapy, inherited disorders with overproduction of uric acid, or rhabdomyolysis

If positive and hyperuricemic symptoms

Obesity
Ethanol
Drugs

Salicylates (low dose)
Diuretics
Pyrazinamide
Ethambutol
Nicotinic acid
Laxative abuse (alkalosis)

Salicylates (low dose)
Diuretics
Pyrazinamide
Ethambutol
Nicotinic acid
Laxative abuse (alkalosis)

Positive

Negative

24-hour urine uric acid

>1100 mg/day

<1100 mg/day

24-hour urine uric acid

>1100 mg/day

<1100 mg/day

Serum urate >11 mg/dl

Serum urate <11 mg/dl