Table 1.
Causes of hypouricemia.
| Inherited disorders of purine metabolism |
|
|
| Genetic defects in the molybdoflavoprotein enzymes: |
| Xanthinuria type I (xanthine oxidoreductase deficiency) |
| Xanthinuria type II (molybdenum cofactor sulfurase deficiency: combined xanthine oxidoreductase and aldehyde oxidase deficiencies) |
| Molybdenum cofactor deficiency |
| Purine nucleoside phosphorylase deficiency |
| Phosphoribosylpyrophosphate synthetase deficiency |
|
|
| Secondary reduction in uric acid biosynthesis |
|
|
| Hepatic failure |
|
|
| Inherited renal hypouricemia (isolated renal tubule reabsorption defect) |
|
|
| Renal hypouricemia-1 [URAT1 (SLC22A12) deficiency] |
| Renal hypouricemia-2 [URAT9 (SLC22A9) deficiency] |
|
|
| Inherited causes of the Fanconi renotubular syndrome and its variants (the syndrome of multiple renal tubule reabsorption defects) |
|
|
| Fanconi renotubular syndrome 1 |
| Cystinosis (accumulation of intralysosomal cystine) |
| Galactosemia (galactose-1-phosphate uridylyltransferase deficiency) |
| Hereditary fructose intolerance (fructose 1-phosphate aldolase B deficiency) |
| Glycogen storage disease type 1 (glucose-6-phosphate deficiency) |
| Wilson’s disease [ATPase, Cu2+ transporting, beta polypeptide (ATP7B) deficiency] |
| Mitochondrial complex IV deficiency (cytochrome c oxidase deficiency) |
|
|
| Acquired causes of the Fanconi renotubular syndrome and its variants |
|
|
| Metal poisoning (e.g., Cd, Zn, Cu, Pb, Hg) |
| Multiple myeloma |
| Nephrotic syndrome |
| Malignant disease |
| Autoimmune disease (e.g., Sjogren’s syndrome) |
| Thermal burns |
| Primary hyperparathyroidism |
| Acute renal tubular necrosis |
| Renal transplant rejection |
|
|
| Drugs |
|
|
| Xanthine oxidoreductase inhibitor (e.g., allopurinol, febuxostat) |
| Drugs used either as uricosuric agents or to block other aspects of renal tubule excretion (e.g., sulfinpyrazone, probenecid, benzbromarone) |
| Non-steroidal anti-inflammatory drugs with uricosuric properties (e.g., phenylbutazone, azapropazone, high dose of aspirin) |
| Coumarin anticoagulants (e.g., warfarin) |
| Outdated tetracycline (5 alpha-6-anhydro-4-epitetracycline) |
|
|
| Nutritional deficiencies |
|
|
| Vitamines B12, C, D |
| Kwashiorkor |