Roos J C, Boer P, Peuker K H, Dorhout Mees E J
Nephron. 1982;32(3):209-13. doi: 10.1159/000182847.
Intrarenal handling of uric acid was studied in 12 patients with essential hypertension under spironolactone treatment (200 mg/day). The degree of volume depletion during treatment was assessed from the changes in body weight and plasma renin activity (PRA). The results are compared with those in patients treated with chlorthalidone (50 mg/day). During spironolactone treatment, the serum uric acid level remained constant despite a progressive volume depletion which after 3 months reached levels identical to those achieved in the chlorthalidone-treated patients, whose serum uric acid level showed the expected rise (21%). The uric acid excretion during spironolactone treatment was markedly diminished (-28%), and thus the 24-hour clearance of uric acid was correspondingly decreased (-22%). It is concluded that spironolactone affects uric acid metabolism in two ways: it causes a decrease in uric acid renal clearance (probably mediated by the induced volume depletion and PRA elevation, as with other saluretics) and, probably, inhibits endogenous uric acid production to approximately the same degree as the clearance is decreased, so that no change in the serum uric acid level occurs. The purpose of the study was to investigate the effect of spironolactone on uric acid handling by the kidney. We found a decrease in uric acid clearance and uric acid excretion. Serum uric acid concentration did not change.
对12例接受螺内酯治疗（200毫克/天）的原发性高血压患者的尿酸肾内处理情况进行了研究。根据体重和血浆肾素活性（PRA）的变化评估治疗期间的血容量减少程度。将结果与接受氯噻酮治疗（50毫克/天）的患者的结果进行比较。在螺内酯治疗期间，尽管血容量逐渐减少，但血清尿酸水平保持不变，3个月后血容量减少程度与氯噻酮治疗的患者相同，后者的血清尿酸水平出现了预期的升高（21%）。螺内酯治疗期间尿酸排泄明显减少（-28%），因此尿酸的24小时清除率相应降低（-22%）。得出的结论是，螺内酯以两种方式影响尿酸代谢：它导致尿酸肾清除率降低（可能像其他利尿剂一样，由诱导的血容量减少和PRA升高介导），并且可能抑制内源性尿酸生成，其程度与清除率降低程度大致相同，因此血清尿酸水平没有变化。该研究的目的是调查螺内酯对肾脏处理尿酸的影响。我们发现尿酸清除率和尿酸排泄减少。血清尿酸浓度没有变化。
