Gout pathophysiology: Difference between revisions

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==Overview==
==Overview==
Gout occurs when mono-sodium urate crystals form on the articular cartilage of joints, on tendons, and in the surrounding tissues. [[Purine metabolism]] gives rise to uric acid, which is normally excreted in the urine. Defects in the kidney may cause uric acid to build up in the blood, leading to [[hyperuricemia]], and the subsequent formation of gout crystals.


== Pathophysiology ==
== Pathophysiology ==  
Gout occurs when mono-sodium urate crystals form on the articular cartilage of joints, on tendons, and in the surrounding tissues. [[Purine metabolism]] gives rise to uric acid, which is normally excreted in the urine. Uric acid is more likely to form into crystals when there is a [[hyperuricaemia]], although it is 10 times more common without clinical gout than with it<ref>{{cite journal | author=Virsaladze D, Tetradze L, Djavashvili L, Esakia N, Tananashvili D. | title=Levels of uric Acid in serum in patients with metabolic syndrome. | journal=Georgian Med News | year=2007 | volume=146 | pages=34&ndash;7 | id=PMID 17595458}}</ref>


Purines can be generated by the body via breakdown of cells in normal cellular turnover, or can be ingested in purine-rich foods such as seafood. The kidneys are responsible for approximately one-third of uric acid excretion, with the gut responsible for the rest. It may be possible that defects in the kidney that may be genetically determined are responsible for the predisposition of individuals for developing gout.
Hyperuricemia is considered an aspect of [[metabolic syndrome]], although its prominence has been reduced in recent classifications. This explains the increased prevalence of gout among [[obesity|obese]] individuals.
Typically, persons with gout are obese, predisposed to diabetes and hypertension, and at higher risk of heart disease. Gout is more common in affluent societies due to a diet rich in proteins, fat, and alcohol.<ref>{{cite book|author = Robert S. Ivker, D.O. , et al | title = The Complete Self-Care guide to Holistic Medicine | year = 1999 | pages=186&ndash;8 | id = ISBN0-87477-986-J}}</ref> It is known that [[Lead(II) acetate|lead sugar]] was used to sweeten wine, and that chronic [[lead poisoning]] is a cause of gout,<ref>{{cite journal | author=Lin JL, Huang PT. | title=Body lead stores and urate excretion in men with chronic renal disease | journal=J Rheumatol | year=1994 | volume=21 | issue=4 | pages=705&ndash;9 | id=PMID 8035397}}</ref><ref>{{cite journal | author=Shadick NA, Kim R, Weiss S, Liang MH, Sparrow D, Hu H. | title=Effect of low level lead exposure on hyperuricemia and gout among middle aged and elderly men: the Normative Aging Study | journal=J Rheumatol | year=2000 | volume=27 | issue=7 | pages=1708&ndash;12 | id=PMID 10914856}}</ref> which condition is then known as '''saturnine gout,''' because of its association with alcohol and excess.<ref>{{cite journal | author=Ball GV. | title=Two epidemics of gout | journal=Bull Hist Med | year=1971 | volume=45 | issue=5 | pages=401&ndash;8 | id=PMID 4947583}}</ref>
===Gross Pathology===
===Gross Pathology===
{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0001.jpg|thumb|Kidney: Uric Acid Deposition: Gross, an excellent example of gouty nephropathy with deposits and excavation in pyramids]]
| [[Image:Gout 0001.jpg|thumb|Kidney: Uric Acid Deposition: Gross, an excellent example of gouty nephropathy with deposits and excavation in pyramids]]
| [[Image:Gout 0002.jpg|thumb|Kidney: Papillary Necrosis: Gross, yellow foci in pyramids, a gout kidney]]
| [[Image:Gout 0002.jpg|thumb|Kidney: Papillary Necrosis: Gross, yellow foci in pyramids, a gout kidney]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0005.jpg|thumb|Bone, synovium: Gout: Gross natural color close-up of extensive uric acid deposits]]
| [[Image:Gout 0005.jpg|thumb|Bone, synovium: Gout: Gross natural color close-up of extensive uric acid deposits]]
| [[Image:Gout 0009.jpg|thumb|Kidney: Gout: Gross natural color close-up view of uric acid deposit in medullary pyramid]]
| [[Image:Gout 0009.jpg|thumb|Kidney: Gout: Gross natural color close-up view of uric acid deposit in medullary pyramid]]
| [[Image:Gout 0034.jpg|thumb|Kidney: Uric Acid Deposition: Gross natural color close-up and excellent view of opaque material in medullary pyramid of adult kidney]]
| [[Image:Gout 0034.jpg|thumb|Kidney: Uric Acid Deposition: Gross natural color close-up and excellent view of opaque material in medullary pyramid of adult kidney]]
|}
|}


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0006.jpg|thumb|Bone, synovium: Gout: Gross natural color section through sternum and clavicle showing very well uric acid deposits in the periarticular tissue]]
| [[Image:Gout 0006.jpg|thumb|Bone, synovium: Gout: Gross natural color section through sternum and clavicle showing very well uric acid deposits in the periarticular tissue]]
| [[Image:Gout 0011.jpg|thumb|Urinary Tract: Staghorn calculi in renal pelvis, Gout ]]
| [[Image:Gout 0011.jpg|thumb|Urinary Tract: Staghorn calculi in renal pelvis, Gout ]]
| [[Image:Gout 0027.jpg|thumb|Gout; Bursa of Knee]]
| [[Image:Gout 0027.jpg|thumb|Gout; Bursa of Knee]]
|}
|}


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0031.jpg|thumb|Kidney: Uric Acid Deposition: Gross, infant kidney with excellent uric acid streaks]]
| [[Image:Gout 0031.jpg|thumb|Kidney: Uric Acid Deposition: Gross, infant kidney with excellent uric acid streaks]]
| [[Image:Gout 0032.jpg|thumb|Kidney: Uric Acid Deposition: Gross good example uric acid streaks in medulla (very ischemic kidney)]]
| [[Image:Gout 0032.jpg|thumb|Kidney: Uric Acid Deposition: Gross good example uric acid streaks in medulla (very ischemic kidney)]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0035.jpg|thumb|Kidney: Uric Acid Infarcts: Gross natural color opened kidney showing marked ischemia with dark red medullary pyramids which contrast sharply with the uric acid deposits]]
| [[Image:Gout 0035.jpg|thumb|Kidney: Uric Acid Infarcts: Gross natural color opened kidney showing marked ischemia with dark red medullary pyramids which contrast sharply with the uric acid deposits]]
| [[Image:Gout 0036.jpg|thumb|Kidney: Uric Acid Infarcts: Gross natural color typical lesion well shown]]
| [[Image:Gout 0036.jpg|thumb|Kidney: Uric Acid Infarcts: Gross natural color typical lesion well shown]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0038.jpg|thumb|Kidney: Uric Acid Infarcts: Gross natural color close-up outstanding photo of the uric acid streaks in medullary pyramids]]
| [[Image:Gout 0038.jpg|thumb|Kidney: Uric Acid Infarcts: Gross natural color close-up outstanding photo of the uric acid streaks in medullary pyramids]]
| [[Image:Gout 0030.jpg|thumb|Knee Joint: Gout. Heavy Deposition of Urate Crystals in Articular Cartilage]]
| [[Image:Gout 0030.jpg|thumb|Knee Joint: Gout. Heavy Deposition of Urate Crystals in Articular Cartilage]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout (no birefringence).jpg|thumb|Gout (Needles, no birefringence, monosodium urate)]]
| [[Image:Gout (no birefringence).jpg|thumb|Gout (Needles, no birefringence, monosodium urate)]]
| [[Image:Gout 0003.jpg|thumb|Skin: Tophus: Micro med mag H&E uric acid deposits with giant cells. Easily recognizable as gout or uric acid tophus]]
| [[Image:Gout 0003.jpg|thumb|Skin: Tophus: Micro med mag H&E uric acid deposits with giant cells. Easily recognizable as gout or uric acid tophus]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0013.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0013.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0014.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0014.jpg|thumb|Bones-Joints: Gout]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0017.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0017.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0018.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0018.jpg|thumb|Bones-Joints: Gout]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0021.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0021.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0022.jpg|thumb|Bones-Joints: Gout, alcohol fixed tissues, monosodium urate crystals]]
| [[Image:Gout 0022.jpg|thumb|Bones-Joints: Gout, alcohol fixed tissues, monosodium urate crystals]]
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{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Gout 0025.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0025.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0026.jpg|thumb|Bones-Joints: Gout]]
| [[Image:Gout 0026.jpg|thumb|Bones-Joints: Gout]]

Revision as of 19:43, 31 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

Gross Pathology

Kidney: Uric Acid Deposition: Gross, an excellent example of gouty nephropathy with deposits and excavation in pyramids
Kidney: Papillary Necrosis: Gross, yellow foci in pyramids, a gout kidney
Bone, synovium: Gout: Gross natural color opened joint with extensive white deposits of uric acid
Bone, synovium: Gout: Gross natural color close-up of extensive uric acid deposits
Kidney: Gout: Gross natural color close-up view of uric acid deposit in medullary pyramid
Kidney: Uric Acid Deposition: Gross natural color close-up and excellent view of opaque material in medullary pyramid of adult kidney
Bone, synovium: Gout: Gross natural color section through sternum and clavicle showing very well uric acid deposits in the periarticular tissue
Urinary Tract: Staghorn calculi in renal pelvis, Gout
Gout; Bursa of Knee
Kidney: Uric Acid Deposition: Gross, infant kidney with excellent uric acid streaks
Kidney: Uric Acid Deposition: Gross good example uric acid streaks in medulla (very ischemic kidney)
Kidney: Uric Acid Nephropathy: Gross, natural color, an excellent view of hydronephrosis with inflamed pelvis and multiple calculi with deposits in medullary pyramids
Kidney: Uric Acid Infarcts: Gross natural color opened kidney showing marked ischemia with dark red medullary pyramids which contrast sharply with the uric acid deposits
Kidney: Uric Acid Infarcts: Gross natural color typical lesion well shown
Kidney: Uric Acid In Medulla: Gross natural color cut surface of kidney uric acid easily seen
Kidney: Uric Acid Infarcts: Gross natural color close-up outstanding photo of the uric acid streaks in medullary pyramids
Knee Joint: Gout. Heavy Deposition of Urate Crystals in Articular Cartilage

Microscopic Pathology

Gout (Needles, no birefringence, monosodium urate)
Skin: Tophus: Micro med mag H&E uric acid deposits with giant cells. Easily recognizable as gout or uric acid tophus
Skin: Tophus: Micro med mag H&E easily recognized uric acid deposit lesion from elbow
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout
Bones-Joints: Gout, alcohol fixed tissues, monosodium urate crystals
Bones-Joints: Gout, alcohol fixed tissues, monosodium urate crystals
Bones-Joints: Gout, alcohol fixed tissues, monosodium urate crystals
Bones-Joints: Gout
Bones-Joints: Gout
Joint: Gout
Joint: Uric Acid Crystals in Acute Gout

Sources

Copyleft images obtained courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA) Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

References

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