Tratamiento de las hiperuricemias

  • Paula Iscoff Hospital Interzonal General de Agudos Presidente Perón, Buenos Aires
  • Carolina Paradiso Fresenius Medical Care, Buenos Aires
  • Guillermo A. De Marziani Centro de Enfermedades Renales e Hipertensión Arterial, Buenos Aires
  • Alicia Ester Elbert Centro de Enfermedades Renales e Hipertensión Arterial, Buenos Aires


El manejo de la hiperuricemia (HU) asintomática y los trastornos asociados al ácido úrico (AU) difieren de acuerdo al contexto clínico del paciente y/o al estadio de la enfermedad renal (ER). Existe una asociación entre los niveles de AU y la hipertensión arterial (HTA), la edad, la enfermedad cardiovascular (ECV) y ER. La causalidad de esta relación es aún hoy un tema controversial, así como el rol del AU en la iniciación, progresión y desarrollo de la ER y en el trasplante. Las modalidades farmacológicas empleadas en el tratamiento de las alteraciones del AU pueden clasificarse según su efecto antiinflamatorio en el ataque agudo, profiláctico para evitar recurrencia o considerar las drogas hipouricemiantes para prevenir o revertir las complicaciones generadas por depósitos de cristales de urato en articulaciones (artropatía gotosa), tracto urinario (litiasis, nefritis tubulointersticial) y tejidos (tofos). Es vital que los valores plasmáticos de uratos sean mantenidos por debajo de 6.8 mg/dl, un nivel por encima del cual podría precipitar; niveles bajos se relacionan a mejor evolución en pacientes con gota, incluyendo menores ataques, mayor rapidez en reducción del tamaño de los tofos y desaparición de cristales de urato monosódico en líquido sinovial.


Loeffler LF, Navas-Acien A, Brady TM, Miller ER 3rd, Fadrowski JJ. Uric acid level and elevated blood pressure in US adolescents: National Health and Nutrition Examination Survey, 1999-2006. Hypertension. 2012;59(4):811-7.

Koenig W, Meisinger C. Uric acid, type 2 diabetes, and cardiovascular diseases: fueling the common soil hypothesis? Clin Chem. 2008;54(2):231-3.

Gaffo AL, Edwards NL, Saag KG. Gout. Hyperuricemia and cardiovascular disease: how strong is the evidence for a causal link? Arthritis Res Ther. 2009;11(4):240.

Sheikhbahaei S, Fotouhi A, Hafezi-Nejad N, Nakhjavani M, Esteghamati A. Serum uric acid, the metabolic syndrome, and the risk of chronic kidney disease in patients with type 2 diabetes. Metab Syndr Relat Disord. 2014;12(2):102-9.

Dousdampanis P, Trigka K, Musso CG, Fourtounas C. Hyperuricemia and chronic kidney disease: an enigma yet to be solved. Ren Fail. 2014;36(9):1351-9.

Kim KM, Kim SS, Yun S, Lee MS, Han DJ, Yang WS, et al. Uric acid contributes to glomerular filtration rate deterioration in renal transplantation. Nephron Clin Pract. 2011;118(2):c136-42.

Shekelle PG, Newberry SJ, FitzGerald JD, Motala A, O’Hanlon CE, Tariq A, et al. Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(1):37-51.

Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol. 2014;26(2):186-91.

Yamanaka H; Japanese Society of Gout and Nucleic Acid Metabolism. Japanese guideline for the management of hyperuricemia and gout: second edition. Nucleosides Nucleotides Nucleic Acids. 2011;30(12):1018-29.

Hamburger M, Baraf HS, Adamson TC 3rd, Basile J, Bass L, Cole B, et al. 2011 Recommendations for the diagnosis and management of gout and hyperuricemia. Postgrad Med. 2011;123(6 Suppl 1):3-36.

Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431-46.

Qaseem A, McLean RM, Starkey M, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(1):52-7.

Sundy JS, Baraf HS, Yood RA, Edwards NL, Gutierrez-Urena SR, Treadwell EL, et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011;306(7):711-20.

Jordan KM, Cameron JS, Snaith M, Zhang W, Doherty M, Seckl J, et al. Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford). 2007;46(8):1372-4.

Bellomo G. Uric acid and chronic kidney disease: A time to act? World J Nephrol. 2013;2(2):17-25.

Stamp LK. Safety profile of anti-gout agents: an update. Curr Opin Rheumatol. 2014;26(2):162-8.

Day RO, Graham GG, Hicks M, McLachlan AJ, Stocker SL, Williams KM. Clinical pharmacokinetics and pharmacodynamics of allopurinol and oxypurinol. Clin Pharmacokinet. 2007;46(8):623-44.

Dalbeth N, Stamp L. Allopurinol dosing in renal impairment: walking the tightrope between adequate urate lowering and adverse events. Semin Dial. 2007;20(5):391-5.

Hande KR, Noone RM, Stone WJ. Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. Am J Med. 1984;76(1):47-56.

Panomvana D, Sripradit S, Angthararak S. Higher therapeutic plasma oxypurinol concentrations might be required for gouty patients with chronic kidney disease. J Clin Rheumatol. 2008;14(1):6-11.

Nguyen DV, Vida C, Chu HC, Fulton R, Li J, Fernando SL. Validation of a Rapid, Robust, Inexpensive Screening Method for Detecting the HLA-B*58:01 Allele in the Prevention of Allopurinol-Induced Severe Cutaneous Adverse Reactions. Allergy Asthma Immunol Res. 2017;9(1):79-84.

Ragab AH, Gilkerson E, Myers M. The effect of 6-mercaptopurine and allopurinol on granulopoiesis. Cancer Res. 1974;34(9):2246-9.

Allopurinol and cytotoxic drugs. Interaction in relation to bone marrow depression. Boston Collaborative Drug Surveillance Program. JAMA. 1974;227(9):1036-40.

Singh JA, Strand V. Gout is associated with more comorbidities, poorer health-related quality of life and higher healthcare utilisation in US veterans. Ann Rheum Dis. 2008;67(9):1310-6.

Febuxostat (Uloric) for chronic treatment of gout. Med Lett Drugs Ther. 2009;51(1312):37-8.

Bruce SP. Febuxostat: a selective xanthine oxidase inhibitor for the treatment of hyperuricemia and gout. Ann Pharmacother. 2006;40(12):2187-94.

Takano Y, Hase-Aoki K, Horiuchi H, Zhao L, Kasahara Y, Kondo S, et al. Selectivity of febuxostat, a novel non-purine inhibitor of xanthine oxidase/xanthine dehydrogenase. Life Sci. 2005;76(16):1835-47.

Mayer MD, Khosravan R, Vernillet L, Wu JT, Joseph-Ridge N, Mulford DJ. Pharmacokinetics and pharmacodynamics of febuxostat, a new non-purine selective inhibitor of xanthine oxidase in subjects with renal impairment. Am J Ther. 2005;12(1):22-34.

Schumacher HR Jr, Becker MA, Lloyd E, MacDonald PA, Lademacher C. Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study. Rheumatology (Oxford). 2009;48(2):188-94.

Deerfield IL. Takeda, Inc Uloric (febuxostat), prescribing information (feb. 2009).

Becker MA, Baraf HS, Yood RA, Dillon A, Vázquez-Mellado J, Ottery FD, et al. Long-term safety of pegloticase in chronic gout refractory to conventional treatment. Ann Rheum Dis. 2013;72(9):1469-74.

Baraf HS, Matsumoto AK, Maroli AN, Waltrip RW 2nd. Resolution of gouty tophi after twelve weeks of pegloticase treatment. Arthritis Rheum. 2008;58(11):3632-4.

Vogt B. Urate oxidase (rasburicase) for treatment of severe tophaceous gout. Nephrol Dial Transplant. 2005;20(2):431-3.

Pui CH, Mahmoud HH, Wiley JM, Woods GM, Leverger G, Camitta B, et al. Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients With leukemia or lymphoma. J Clin Oncol. 2001;19(3):697-704.

Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26(16):2767-78.

Sonbol MB, Yadav H, Vaidya R, Rana V, Witzig TE. Methemoglobinemia and hemolysis in a patient with G6PD deficiency treated with rasburicase. Am J Hematol. 2013;88(2):152-4.

Allen KC, Champlain AH, Cotliar JA, Belknap SM, West DP, Mehta J, et al. Risk of anaphylaxis with repeated courses of rasburicase: a Research on Adverse Drug Events and Reports (RADAR) project. Drug Saf. 2015;38(2):183-7.

Bach MH, Simkin PA. Uricosuric drugs: the once and future therapy for hyperuricemia? Curr Opin Rheumatol. 2014;26(2):169-75.

Enomoto A, Kimura H, Chairoungdua A, Shigeta Y, Jutabha P, Cha SH, et al. Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature. 2002;417(6887):447-52.

Stocker SL, Graham GG, McLachlan AJ, Williams KM, Day RO. Pharmacokinetic and pharmacodynamic interaction between allopurinol and probenecid in patients with gout. J Rheumatol. 2011;38(5):904-10.

Weinberger A, Schindel B, Liberman UA, Pinkhas J, Sperling O. Calciuric effect of probenecid in gouty patients. Isr J Med Sci. 1983;19(4):377-9.

Bobulescu IA, Moe OW. Renal transport of uric acid: evolving concepts and uncertainties. Adv Chronic Kidney Dis. 2012;19(6):358-71.

Feher MD, Hepburn AL, Hogarth MB, Ball SG, Kaye SA. Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout. Rheumatology (Oxford). 2003;42(2):321-5.

Huang HY, Appel LJ, Choi MJ, Gelber AC, Charleston J, Norkus EP, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum. 2005;52(6):1843-7.

Fessel WJ. Renal outcomes of gout and hyperuricemia. Am J Med. 1979;67(1):74-82.

Becker MA, Dalbeth N, Romain PL. Prevention of recurrent gout: Pharmacologic urate-lowering therapy and treatment of tophi [Internet]. En: UpToDate (citado 22 mar. 2017]. Disponible en:

International Society of Nephrology. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Chapter 3: Management of progression and complications of CKD. Kidney Int Suppl. 2013;3(1):73-90.

Leung YY, Yao Hui LL, Kraus VB. Colchicine--Update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum. 2015;45(3):341-50.

Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. High versus low dosing of oral colchicine for early acute gout flare: Twentyfour-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060-8.

Ahern MJ, Reid C, Gordon TP, McCredie M, Brooks PM, Jones M. Does colchicine work? The results of the first controlled study in acute gout. Aust N Z J Med. 1987;17(3):301-4.

Sutaria S, Katbamna R, Underwood M. Effectiveness of interventions for the treatment of acute and prevention of recurrent gout--a systematic review. Rheumatology (Oxford). 2006;45(11):1422-31.

Zhang S, Zhang Y, Liu P, Zhang W, Ma JL, Wang J. Efficacy and safety of etoricoxib compared with NSAIDs in acute gout: a systematic review and a metaanalysis. Clin Rheumatol. 2016;35(1):151-8.

Schumacher HR Jr, Boice JA, Daikh DI, Mukhopadhyay S, Malmstrom K, Ng J, et al. Randomised double blind trial of etoricoxib and indometacin in treatment of acute gouty arthritis. BMJ. 2002;324(7352):1488-92.

Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007;115(12):1634-42.

Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a doubleblind, randomized, controlled trial. Ann Emerg Med. 2007;49(5):670-7.

Janssens HJ, Janssen M, van de Lisdonk EH, van Riel PL, van Weel C. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008;371(9627):1854-60.

Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447-61.

Chakraborty A, Van LM, Skerjanec A, Floch D, Klein UR, Krammer G, et al. Pharmacokinetic and pharmacodynamic properties of canakinumab in patients with gouty arthritis. J Clin Pharmacol. 2013;53(12):1240-51.

So A, De Smedt T, Revaz S, Tschopp J. A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis Res Ther. 2007;9(2):R28.

Terkeltaub RA, Schumacher HR, Carter JD, Baraf HS, Evans RR, Wang J, et al. Rilonacept in the treatment of acute gouty arthritis: a randomized, controlled clinical trial using indomethacin as the active comparator. Arthritis Res Ther. 2013;15(1):R25.

Economides AN, Carpenter LR, Rudge JS, Wong V, Koehler-Stec EM, Hartnett C, et al. Cytokine traps: multi-component, high-affinity blockers of cytokine action. Nat Med. 2003;9(1):47-52.

Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1312-24.

Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum. 2004;51(3):321-5.

Cómo citar
Iscoff P, Paradiso C, De Marziani GA, Elbert AE. Tratamiento de las hiperuricemias. Rev Nefrol Dial Traspl. [Internet]. 17 de junio de 2017 [citado 12 de julio de 2024];37(2):104-1. Disponible en:
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