Gout is a monosodium urate crystal deposition disease. Formation of the crystals requires high serum uric acid levels; the local factors responsible for their predilection for the joints are only started to be grasped.^1,2 Steady serum urate levels result from the balance between its production and excretion; hyperuricaemia results when formation is increased or difficulties in (mostly) renal excretion occur. In humans, urate is the final breakdown product of purine nucleotides, constituents of cellular energy stores such as ATP, and of DNA and RNA both internal or, to a lesser extent, ingested.

Increased urate formation is the cause of hyperuricaemia and gout in some well defined enzymatic defects, and also occurs as a consequence of increased destruction of cells in some malignancies, polycythaemia vera or some haemolytic anaemias. Patients with increased production of urate are classified as overproducers, and detection of an increased amount of excreted urate is considered to be a good method of detecting the few patients whose gout results either from enzymatic defects—which are partial in the adult—or a tumour or other condition with a rapid cellular turnover.³

Two thirds of urate excretion occurs at the kidney, the remainder being excreted by the gut. In an estimated 85–90% cases, gout results from poor renal disposal of urate. Gouty patients with normal or low excretion of uric acid (underexcretors) may be candidates for treatment with uricosuric drugs with little risk of urinary calculi. Measurement of the amount of excreted urate has also been recommended to identify these patients.

Measurement of the amount of excreted uric acid has been considered to have clinical implications. However, …