The Journal is included in Russian and International Library and Abstract Databases
Russain Science Index (Russia)
DOI Registration Agency (USA)

Hyperuricemia and tuberculosis


Professor O. Komissarova(1, 2), MD; Professor R. Abdullaev(1), MD; S. Aleshina(1) (1)Central
Research Institute of Tuberculosis, Moscow (2)N.I. Pirogov Russian National Research Medical University,

The paper provides an update on the mechanism of hyperuricemia, its impact on different organs and systems. It analyzes the data available in the literature on the frequency and characteristics of hyperuricemia in patients with tuberculosis both before the start of treatment and during therapy. The paper also highlights the potential complications of prolonged hyperuricemia and approaches to its combination treatment for pulmonary tuberculosis.

uric acid

  1. Abdullaev R.Ju., Komissarova O.G., Chumakova E.S. i dr. Uroven' mochevoj kisloty v syvorotke krovi u bol'nyh vpervye vyjavlennym tuberkulezom legkih s mnozhestvennoj lekarstvennoj ustojchivost'ju vozbuditelja. Tuberkulez i bolezni legkih. 2017; 95 (4): 31–6 [Abdullaev R.Y., Komissarova O.G., Chumakova E.S. et al. Level of uric acid in blood serum of new pulmonary tuberculosis with multiple drug resistance. Tuberculosis and Lung Diseases. 2017; 95 (4): 31–6 (in Russ.)].
  2. Eliseeva M.E., Eliseev M.S. Giperurikemija kak faktor riska razvitija patologii pochek i perspektivy uratsnizhajuschej terapii. Effektivnaja farmakoterapija. 2019; 15 (23): 26–30 [Yeliseyeva M.Ye., Yeliseyev M.S. Hyperuricemia as a Risk Factor for Development of Renal Pathology and the Prospects for Urate Lowering Therapy. Effektivnaya farmakoterapiya. 2019; 15 (23): 26–30 (in Russ.)].
  3. Eliseev M.S., Barskova V.G., Denisov I.S. Dinamika klinicheskih projavleniĭ podagry u muzhchin (dannye 7-letnego prospektivnogo nabljudenija). Ter arh. 2015; 87 (5): 10–5 [Eliseev M.S., Barskova V.G., Denisov I.S. Time course of changes in the clinical manifestations of gout in men: Data of a 7-year retrospective follow-up. Ter arkh. 2015; 87 (5): 10–5 (in Russ.)].
  4. Ivanova D.A., Borisov S.E., Ryzhov A.M. Giperurikemija pri lechenii bol'nyh tuberkulezom: klinicheskoe znachenie, faktory riska, printsipy monitoringa. Tuberkulez i sotsial'no-znachimye zabolevanija. 2017; 3: 24–31 [Ivanova D.A., Borisov S.E., Ryzhov A.M. Hyperuricemia during anti-tuberculosis therapy: clinical significance, risk factor and monitoring strategies. Tuberkulez i social’no-znachimye zabolevaniya. 2017; 3: 24–31 (in Russ.)].
  5. Madjanov I.V. Giperurikemija i saharnyj diabet. RMZh. Meditsinskoe obozrenie. 2019; 1 (I): 20–4 [Madyanov I.V. Hyperurichemia and diabetes mellitus. RMJ. Medical Review. 2019; 1 (I): 20–4 (in Russ.)].
  6. Rameev V.V., Eliseev M.S., Moiseev S.V. Kontseptsija autovospalenija v geneze podagry i giperurikemii. Klinicheskaja farmakologija i terapija. 2019; 28 (2): 28–33 [Rameev V.V., Eliseev M.S., Moiseev S.V. Autoinflammation in the pathogenesis of gout and hyperuricemia. Clinical pharmacology and therapy. 2019; 28 (2): 28–33 (in Russ.)]. 10.32756/0869-5490-2019-2-28-33
  7. Federal'nye klinicheskie rekomendatsii po diagnostike i lecheniju tuberkuleza organov dyhanija s mnozhestvennoj i shirokoj lekarstvennoj ustojchivost'ju vozbuditelja. M.; Tver': OOO «Izdatel'stvo «Triada», 2014; 72 s. [Federal’nye klinicheskie rekomendacii po diagnostike i lecheniyu tuberkuleza organov dyhaniya s mnozhestvennoj i shirokoj lekarstvennoj ustojchivost’yu vozbuditelya. M.; Tver’: OOO «Izdatel’stvo «Triada», 2014; 72 s. (in Russ.)].
  8. Adebisi S.A., Oluboyo P.O., Okesina A.B. Effect of drug-induced hyperuricaemia on renal function in Nigerians with pulmonary tuberculosis. Afr J Med Med Sci. 2000; 29 (3–4): 297–300.
  9. Benn C.L., Dua P., Gurrell R. et al. Physiology of hyperuricemia and urate-lowering treatments. Front Med (Lausanne). 2018; 5: 160. DOI: 10.3389/fmed.2018.00160
  10. Pokam B.D.T., Enoh J. et al. Uric acid levels in patients on antituberculosis drugs in the Southwest region of Cameroon. Int J Mycobacteriol. 2016; 5 (Suppl. 1): S116. DOI: 10.1016/j.ijmyco.2016.09.058
  11. Chang H.Y., Lee P.H., Lei C.C. et al. Hyperuricemia is an independent risk factor for new onset micro-albuminuria in a middle-aged and elderly population: a prospective cohort study in Taiwan. PLoS One. 2013; 8 (4): e61450. DOI: 10.1371/journal.pone.0061450
  12. Gerdan V., Akkoc N., Ucan E. S. et al. Paradoxical increase in uric acid level with allopurinol use in pyrazinamide-induced hyperuricaemia. Singapore Med J. 2013; 54: 125–6. DOI: 10.11622/smedj.2013097
  13. Cheong, E., Ryu S., Lee J.Y. Association between serum uric acid and cardiovascular mortality and all-cause mortality: a cohort study. J Hypertens. 2017; 35 (Suppl. 1): S3–S9. DOI: 10.1097/HJH.0000000000001330
  14. Gibbs B.F., Gonçalves Silva I., Prokhorov A. et al. Caffeine affects the biological responses of human hematopoietic cells of myeloid lineage via downregulation of the mTOR pathway and xanthine oxidase activity. Oncotarget. 2015; 6 (30): 28678–92. DOI: 10.18632/oncotarget.5212
  15. Gutman A.B., Yu T.F., Berger L. Renal function in gout. Estimation of tubular secretion and reabsorption of uric acid by use of pyrazinamide (pyrazinoic acid). Am J Med. 1969; 47 (4): 575–92. DOI: 10.1016/0002-9343(69)90188-0
  16. Harris A., Siegel L., Alloway J. Gout and hyperuricemia. Am Fam Phys. 1999; 59 (4): 925–34.
  17. Hayashino Y., Okamura S., Tsujii S. et al. Association of serum uric acid levels with the risk of development or progression of albuminuria among Japanese patients with type 2 diabetes: a prospective cohort study. Acta Diabetologica. 2016; 53 (4): 599–607. DOI: 10.1007/s00592-015-0825-x
  18. Horsfall P.A., Plummer J., Allan W.G. et al. Double blind controlled comparison of aspirin, allopurinol and placebo in the management of arthralgia during pyrazinamide administration. Tubercle. 1979; 60: 13–24. DOI: 10.1016/0041-3879(79)90051-5
  19. Hsieh Y.P., Chang C.C., Yang Y. et al. The role of uric acid in chronic kidney disease patients. Nephrology (Carlton). 2017; 22 (6): 441–8. DOI: 10.1111/nep.12679
  20. Inayat N., Shah R.H., Lakhair M.A. et al. Hyperuricemia and arthralgia during pyrazinamide therapy in patients with pulmonary tuberculosis. Pak J Chest Med. 2016; 22 (4): 154–8.
  21. Inoue T., Ikeda N., Kurasawa T. et al. Hyperuricemia and arthralgia during pyrazinamide treatment. Nihon Kokyuki Gakkai Zasshi. 1999; 37: 115–8.
  22. Joosten L.A.B., Crişan T.O., Bjornstad P. et al. Asymptomatic hyperuricaemia: a silent activator of the innate immune system. Nat Rev.Rheumatol. 2020; 16 (2): 75–86.
  23. Kim Y., Kang J., Kim G.T. Prevalence of hyperuricemia and its associated factors in the general Korean population: an analysis of a population-based nationally representative sample. Clin Rheumatol. 2018; 37: 2529–38. DOI: 10.1007/s10067-018-4130-2
  24. Lacroix C., Guyonnaud C., Chaou M. et al. Interaction between allopurinol and pyrazinamide. Eur Respir J. 1988; 1: 807–11.
  25. Liu Y., Yan L., Lu J. et al. A pilot study on the epidemiology of hyperuricemia in Chinese adult population based on big data from Electronic Medical Records 2014 to 2018. Minerva Endocrinol. 2020; 45 (2): 97–105.
  26. Louthrenoo W., Hongsongkiat S., Kasitanon N. et al. Effect of Antituberculous Drugs on Serum Uric Acid and Urine Uric Acid Excretion. J Clin Rheumatol. 2015; 21 (7): 346–8. DOI: 10.1097/RHU.0000000000000297
  27. Lu J., He Y., Cui L. et al. Hyperuricemia Predisposes to the Onset of Diabetes via Promoting Pancreatic β-Cell Death in Uricase Deficiency Male Mice. Diabetes. 2020; 69 (6): 1149–63.
  28. Mahantesh A., Hanumantharayappa B., Madhava R.P. et al. Effect of pyrazinamide induced hyperuricemia on patient compliance undergoing DOTS therapy for tuberculosis. RRJPTS. 2014; 2 (2): 12–8.
  29. Maloberti A., Giannattasio C., Bombelli M. et al. Hyperuricemia and Risk of Cardiovascular Outcomes: The Experience of the URRAH (Uric Acid Right for Heart Health) Project. High Blood Press Cardiovasc Prev. 2020; 27 (2): 1218. 10.1007/s40292-020-00368-z
  30. Ndrepepa G. Uric acid and cardiovascular disease. Clin Chim Acta. 2018; 484: 150–63. DOI: 10.1016/j.cca.2018.05.046
  31. Park R., Kang M.G. Association Between Serum Uric Acid and Prediabetes in the Korean General Population. Asia Pac J Public Health. 2019; 31 (8): 719–27.
  32. Pichholiya M., Yadav A.K., Luhadia S.K. et al. A comparative study of efficacy and safety of febuxostat and allopurinol in pyrazinamide-induced hyperuricemic tubercular patients. Indian J Pharmacol. 2016; 48 (5): 522–5. DOI: 10.4103/0253-7613.190729
  33. Pichholiya, M., Yadav A.K., Kothari N. Effect of diet, body mass index, and proton pump inhibitors on antitubercular therapy–induced hyperuricemia in patients of tuberculosis. Natl J Physiol Pharm Pharmacol. 2016; 6 (2):158–61. DOI: 10.5455/njppp.2016.6.1412201510
  34. Pillai A.P., Maldhure B.R., Zodpey S.P. Hyperuricemia during anti-tuberculous treatment. Lung India. 1998; 17: 19–22.
  35. Postlethwaite A.E., Bartel A.G., Kelley W.N. Hyperuricemia due to ethambutol. N Engl J Med. 1972; 286: 761–2. DOI: 10.1056/NEJM197204062861407
  36. Qureshi W., Hassan G., Kadri S.M. et al. Hyperuricemia and arthralgias during pyrazinamide therapy in patients with pulmonary tuberculosis. Lab Med. 2007; 38: 495–7.
  37. Rafiullah M., Siddiqui K., Al-Rubeaan K. Association between serum uric acid levels and metabolic markers in patients with type 2 diabetes from a community with high diabetes prevalence. Int J Clin Pract. 2020; 74 (4): e13466.
  38. Sedaghat S., Hoorn E.J., van Rooij F.J. et al. Serum uric acid and chronic kidney disease: the role of hypertension. PLoS One. 2013; 8 (11): e76827. DOI: 10.1371/journal.pone.0076827
  39. Sismanlar T., Aslan A.T., Budakoglu I. Is hyperuricemia overlooked when treating pediatric tuberculosis patients with pyrazinamide? J Trop Pediatr. 2015; 61: 351–6. DOI: 10.1093/tropej/fmv042
  40. Solangi G.A., Zuberi B.F., Shaikh S. et al. Pyrazinamide induced hyperuricemia in patients taking anti-tuberculous therapy. J Coll Physicians Surg Pak. 2004; 14 (3): 136–8.
  41. Taki H., Ogawa K., Murakami T. et al. Epidemiological survey of hyperuricemia as an adverse reaction to antituberculous therapy with pyrazinamide. Kekkaku. 2008; 83: 497–501.
  42. Tosun A.K., Koca N.T., Karataş G.K. Acute gouty arthritis during pyrazinamide treatment: a case report. Mod Rheumatol. 2004; 14 (4): 306–8.
  43. Wang J., Pang Yu., Jing W. et al. Efficacy and safety of cycloserine-containing regimens in the treatment of multidrug-resistant tuberculosis: a nationwide retrospective cohort study in China. Infect Drug Resist. 2019; 12: 763–70. DOI: 10.2147/IDR.S194484
  44. Woldeamlak B., Yirdaw K., Biadgo B. Hyperuricemia and its Association with Cardiovascular Disease Risk Factors in Type Two Diabetes Mellitus Patients at the University of Gondar Hospital, Northwest Ethiopia. EJIFCC. 2019; 30 (3): 325–39.
  45. Zhou Y., Fang L., Jiang L. et al. Uric acid induces renal inflammation via activating tubular NF-kB signaling pathway. PLoS One. 2012; 7 (6): e39738.
  46. Zhu Y., Pandya B.J., Choi H.K. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011; 63: 3136–41. DOI: 10.1002/art.30520