Hyperuricemia, hypertension, and proteinuria associated with high-altitude polycythemia

J. Ashley Jefferson, Elizabeth Escudero, Maria Elena Hurtado, Jackeline Pando Kelly, Erik R. Swenson, Mark H. Wener, Michel Burnier, Marc Maillard, George F. Schreiner, Robert B. Schoene, Abdias Hurtado, Richard J. Johnson

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Abstract

Chronic exposure to high altitude is associated with the development of erythrocytosis, proteinuria, and, in some cases, hyperuricemia. We examined the relationship between high-altitude polycythemia and proteinuria and hyperuricemia in Cerro de Pasco, Peru (altitude, 4,300 m). We studied 25 adult men with hematocrits less than 65% and 27 subjects with excessive erythrocytosis (EE; hematocrit > 65%) living in Cerro de Pasco, Peru and compared them with 28 control subjects living in Lima, Peru (at sea level) and after 48 hours of exposure to high altitude. Serum urate levels were significantly elevated in patients with EE at altitude, and gout occurred in 4 of 27 of these subjects. Urate level strongly correlated with hematocrit (r = 0.71; P < 0.0001). Urate production (24-hour urine urate excretion and urine urate-creatinine ratio) was increased in this group compared with those at sea level. Fractional urate excretion was not increased, and fractional lithium excretion was reduced, in keeping with increased proximal reabsorption of filtrate. Significantly higher blood pressures and decreased renin levels in the EE group were in keeping with increased proximal sodium reabsorption. Serum urate levels correlated with mean blood pressure (r = 0.50; P < 0.0001). Significant proteinuria was more prevalent in the EE group despite normal renal function. Hyperuricemia is common in subjects living at high altitude and associated with EE, hypertension, and proteinuria. The increase in uric acid levels appears to be caused by increased urate generation secondary to systemic hypoxia, although a relative impairment in renal excretion also may contribute.

Original languageEnglish (US)
Pages (from-to)1135-1142
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume39
Issue number6
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Nephrology

Keywords

  • Altitude
  • Hypertension
  • Hyperuricemia
  • Polycythemia
  • Proteinuria
  • Uric acid

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    Jefferson, J. A., Escudero, E., Hurtado, M. E., Kelly, J. P., Swenson, E. R., Wener, M. H., Burnier, M., Maillard, M., Schreiner, G. F., Schoene, R. B., Hurtado, A., & Johnson, R. J. (2002). Hyperuricemia, hypertension, and proteinuria associated with high-altitude polycythemia. American Journal of Kidney Diseases, 39(6), 1135-1142. https://doi.org/10.1053/ajkd.2002.33380