Clinical Biochemistry: Hyperuricemia and Gout

Biochemistry · Basic Sciences

How it begins

Estudio en profundidad del metabolismo de los nucleótidos de purina, la cinética de aclaramiento renal e intestinal del urato, los determinantes termodinámicos de la nucleación de cristales de urato monosódico y la biología de la inflamación estéril mediada por el inflamasoma NLRP3 y las interleucinas proinflamatorias.

What it covers

1. Introduction, Definition and Molecular Epidemiological Context
2. · Historical Evolution of Biochemical Understanding
3. Biochemistry of De Novo Synthesis of Purine Nucleotides
4. · Phases and Enzymatic Flow of De Novo Synthesis
5. · Ring Construction Stoichiometry
6. The Purine Rescue Pathway and its Energy Balance
7. · Enzymology of Recovery
8. · Thermodynamic Interconnection and Cross Control
9. Purine Catabolism and Uric Acid Biosynthesis
10. · Enzymatic Route of Degradation
11. · Xanthine Oxidase: Molecular Biology and Isoforms
12. · The Mutation of the Uricase Gene and its Physiological Impact
13. Excretory Physiology of Urate I: Dynamics of Renal Transport
14. · The Four Component Model of Renal Management
15. · Molecular Biology of the Urate Transportosome
16. Excretory Physiology of Urate II: Intestinal Secretion and Uricolysis
17. · The Enterocyte Secretion Machinery
18. · Uricolysis by the Intestinal Microbiome
19. Etiopathogenesis of Hyperuricemia: Classification of Physiological Basis
20. · 1. Uric Acid Hyperproducers (~10% of gout cases)
21. · 2. Hypoexcretors of Uric Acid (~90% of gout cases)
22. Physical Biochemistry of Urate: Mechanisms of Supersaturation and Nucleation
23. · UMS Crystal Nucleation Physics
24. Pathophysiology of Inflammation Induced by UMS Crystals
25. · Phase I: Crystal Recognition and Phagocytosis
26. · Phase II: The Assembly of the NLRP3 Inflammasome
27. · Phase III: Massive Neutrophil Infiltration and NETosis
28. Immunobiology and Histopathology of Chronic Gouty Tophus
29. · Concentric Architecture of the Gotoso Tofo
30. · Cartilaginous and Subchondral Bone Destruction
31. Clinical Presentations of Gout and its Natural Evolution
32. · Clinical Phases of the Gout Spectrum
33. Kidney Compromise: Urate Nephropathies and Urolithiasis
34. · 1. Acute Uric Acid Nephropathy
35. · 2. Chronic Urate Nephropathy (Interstitial)
36. · 3. Uric Acid Urolithiasis
37. Urate Physiopathology in Cardiovascular and Metabolic Risk
38. · The Urate Paradox: Extracellular Antioxidant vs Intracellular Prooxidant
39. Laboratory Diagnostic Methodologies in Hyperuricemia and Gout
40. · 1. Quantification of Uric Acid in Serum
41. · 2. Characterization of Urate Clearance in 24-Hour Urine
42. · 3. Analysis of Synovial Fluid under Compensated Polarized Light
43. Advanced Diagnostic Imaging: Ultrasonography and DECT
44. · 1. High Resolution Ultrasonography (Joint)
45. · 2. Dual Energy Computed Tomography (DECT)
46. Pharmacology of Acute Gout Attack and Prophylaxis
47. · 1. Colchicine: Molecular Mechanism of Action
48. · 2. Nonsteroidal Anti-Inflammatories (NSAIDs)
49. · 3. Corticosteroids (Glucocorticoids)
50. · 4. Anti-Interleukin-1 Biological Therapy (IL-1 Inhibitors)
51. Chronic Hypoglycemic Therapy (ULT) and New Frontiers
52. · 1. Xanthine Oxidase Inhibitors (IXO)
53. · 2. Uricosuric Agents (URAT1 Inhibitors)
54. · 3. Uricolytic Agents: Uricase Enzyme Replacement