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A simple method of selecting gout patients for treatment with uricosuric agents, using spot urine and blood samples
Tetsuya Yamamoto1, Yuji Moriwaki, Sumio Takahashi
1Department of Internal Medicine, Hyogo College of Medicine, Japan. tetsuya@hyo-med.ac.jp
Objective:
To develop a simple means of selecting gout patients for treatment with uricosuric agents.
Methods:
In 124 gout patients, spot urine and blood were sampled before breakfast and after overnight fast (except water) on the day of 24 h urine collection. Spot urine uric acid/creatinine ratio (Ua/Cr mmol/mmol) and serum creatinine x Ua/Cr (Scr*Ua/Cr micromol/l) were calculated together with 24 h urinary uric acid excretion/body surface (24 Ua/S). The patients were then classified either below or above 2.84 mmol/m2/day for 24 Ua/S.
Results:
Classifications based on spot urine Ua/Cr (cut off value set at 0.34), spot urine Scr*Ua/Cr (cut off value set at 28.1), and a combination of spot urine Ua/Cr and Scr*Ua/Cr were found to be not significantly different in diagnostic accuracy for the detection of patients with 24 Ua/S below 2.84 mmol/m2 (77%, 81%, and 81%, respectively) and sensitivity (80%, 83%, and 76%, respectively). However, specificity by a combination of spot urine Ua/Cr, and spot urine Scr*Ua/Cr was higher than by spot urine Ua/Cr alone (91% vs 74%, P < 0.05), although the specificity was not significantly different between a combination and spot urine Scr*Ua/Cr alone (91% vs 78%) or between spot urine Ua/Cr and spot urine Scr*Ua/Cr (74% vs 78%).
Conclusion:
A combination of spot urine Ua/Cr and spot urine Scr*Ua/Cr may be clinically useful in selecting gout patients with 24 Ua/S below 2.84 mmol/m2 for treatment with uricosuric agents without adverse effects.