Transplantation. Jul 27;66(2) Uricosuric effect of the angiotensin II receptor antagonist losartan in heart transplant recipients. Minghelli G(1). This agent promotes uric acid excretion via effects on the organic anion transport The AIIA losartan also produces a uricosuric effect in healthy volunteers. Uricosuric medications (drugs) are substances that increase the excretion of uric acid in the urine, thus reducing the concentration of uric acid in blood plasma. In general, this effect is achieved by action on the proximal tubule of the the uricosurics benzbromarone and losartan had no effect, suggesting these drugs act.
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ARBs inhibit the activity of angiotensin II, a potent vasoconstrictor that is formed through a conversion from angiotensin I by angiotensin-converting enzyme ACE [ Michel et al. In the hydrochlorothiazide monotherapy group, uric acid levels increased from 8.
Author information Copyright and License information Disclaimer. Conclusion This review explored evidence for ARBs and the reduction of serum uric acid levels and increased fractional excretion of uric acid. Excess urate excretion correlates with severely acidic urine in patients with renal lossrtan.
Many individuals with hypertension are treated with thiazide diuretics, which can cause hyperuricemia. Several gout attacks occurred through each phase of the study. These drugs include all diureticspyrazinoatepyrazinamide etfect, ethambutolniacinand aspirin. Shahinfar and colleagues conducted a double-blind, placebo-controlled, parallel study with 63 patients to explore the safety and efficacy of losartan in individuals with thiazide-induced hyperuricemia [ Shahinfar et al.
From those, eight studies met criteria [ Rayner et al. Losartan was the only ARB which was found to reduce serum uric acid levels and to increase the excretion uricosueic uric acid in all the studies discussed in this review [ Rayner et al. As the primary outcome, the uric acid levels of the losartan group decreased from 7.
Uricosuric – Wikipedia
View large Download slide. Many medication therapies have secondary uricosuric effects, and although used for alternate primary indications, can assist urifosuric agents in reducing serum uric acid levels.
It is important to continue to monitor for the side effects that were found within the studies, as well as the common adverse effects associated with ARB use. The urucosuric of hyperuricemia has also been associated with poor health-related losarfan including myocardial infarction MIstroke and nephrolithiasis [ Zhu et al. The literature regarding the potential uricosuric effects of other ARBs is either inconclusive or nonexistent.
Studies were excluded that did not explore fractional excretion or serum uric acid as an endpoint, if patients did not have a diagnosis of gout or hyperuricemia at baseline, or if they were non-English language. Effect of losartan on renal excretion of urate in a hypouricemic hypertensive patient no.
Future prospective, randomized, placebo-controlled studies should include larger patient populations, and should explore more relatable and generalizable effcet such as gout attack free periods or incidence of gout attacks.
All changes in clinical and biochemical parameters were reported. Losartan demonstrated statistically significant reductions in serum uric acid levels or increases in fractional excretion of uric acid in all studies, whereas no other ARB reached statistical benefit.
Candesartan did not influence Sur 5. Ann Intern Med A novel type of renal hypouricemia. Sign In or Create an Account. The ACR Guidelines endorse the use of additional uricosuric agents such as fenofibrate and losartan in combination with xanthine oxidase inhibitors if target urate levels are not met uricosufic first-line agents alone [ Khanna et al. Open in a separate window. Pak J Pharm Sci Effects of the angiotensin II antagonist valsartan on blood pressure, proteinuria, and renal hemodynamics in patients with chronic renal failure and hypertension.
Obesity, weight change, hypertension, diuretic use, and risk of gout in men: Changes in lab values such as elevations in serum creatinine and potassium were noted; however, these results were deemed clinically insignificant as they remained within normal uriicosuric [ Dang et al. Cardiovascular drugs and serum uric acid.
Gout and its comorbidities. J Pharmacol Exp Ther From Wikipedia, the free encyclopedia. Conflict of interest statement: Losartan showed a slightly higher hypotensive effect than valsartan in patients newly diagnosed with gout.
Further studies with additional ARBs could be beneficial in determining if any of the other agents within this class are able to exert similar effects to losartan. Four individuals experienced an acute gouty attack after being switched from losartan back to enalapril therapy.
A total of 57 patients were analyzed at 12 weeks. Candesartan and irbesartan were the other ARBs found in the literature that were compared to losartan for their potential uricosuric effects.
URAT1 serves as a urate—anion exchanger in the proximal tubule of the kidney and is a key target for uricosuric agents [ Choi et al. Thirty-two newly-diagnosed gout patients, whose blood pressure was controlled using losartan for at least 3 months were included.
Since these adverse effects did not disappear after changing back to losartan at the end of stage III, we performed an additional 3-month follow-up stage. There was no safety analysis conducted in this study [ Khan et al. Nat Rev Rheumatol 6: These findings highlight a niche for the incorporation of losartan into therapeutic regimens for individuals with thiazide diuretic-induced hyperuricemia.
A tribute to Scipione Riva-Rocci. A venous blood sample was drawn halfway through each clearance phase.