Isolated defect in postsecretory reabsorption of uric acid

A 26-year-old woman was found to have an abnormally sensitive excretory response to a rise in plasma urate with a markedly increased ratio of uric acid to creatinine clearance (exceeding 35%). Uric acid was studied before and after administration of pyrazinamide and benzbromarone. In the presence of pyrazinamide urinary uric acid decreased markedly just as in normal subjects. The uricosuric response to benzbromarone was reduced. No other renal tubular or metabolic abnormalities were found. It appears that the abnormality is related to an isolated defect in postsecretory reabsorption of urate.