Open Access Open Badges Research article

Fractional clearance of urate: validation of measurement in spot-urine samples in healthy subjects and gouty patients

Diluk RW Kannangara12, Sheena N Ramasamy12, Praveen L Indraratna1, Sophie L Stocker13, Garry G Graham12, Graham Jones4, Ian Portek5, Kenneth M Williams12 and Richard O Day12*

Author affiliations

1 Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, New South Wales 2010, Australia

2 Department of Pharmacology, University of New South Wales, Wallace Wurth Building, Sydney, New South Wales 2052, Australia

3 Faculty of Pharmacy, University of Sydney, Pharmacy and Bank Building, Sydney, New South Wales 2006, Australia

4 Department of Chemical Pathology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, New South Wales 2010, Australia

5 Department of Rheumatology, St George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia

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Citation and License

Arthritis Research & Therapy 2012, 14:R189  doi:10.1186/ar4020

Published: 17 August 2012



Hyperuricemia is the greatest risk factor for gout and is caused by an overproduction and/or inefficient renal clearance of urate. The fractional renal clearance of urate (FCU, renal clearance of urate/renal clearance of creatinine) has been proposed as a tool to identify subjects who manifest inefficient clearance of urate. The aim of the present studies was to validate the measurement of FCU by using spot-urine samples as a reliable indicator of the efficiency of the kidney to remove urate and to explore its distribution in healthy subjects and gouty patients.


Timed (spot, 2-hour, 4-hour, 6-hour, 12-hour, and 24-hour) urine collections were used to derive FCU in 12 healthy subjects. FCUs from spot-urine samples were then determined in 13 healthy subjects twice a day, repeated on 3 nonconsecutive days. The effect of allopurinol, probenecid, and the combination on FCU was explored in 11 healthy subjects. FCU was determined in 36 patients with gout being treated with allopurinol. The distribution of FCU was examined in 118 healthy subjects and compared with that from the 36 patients with gout.


No substantive or statistically significant differences were observed between the FCUs derived from spot and 24-hour urine collections. Coefficients of variation (CVs) were both 28%. No significant variation in the spot FCU was obtained either within or between days, with mean intrasubject CV of 16.4%. FCU increased with probenecid (P < 0.05), whereas allopurinol did not change the FCU in healthy or gouty subjects. FCUs of patients with gout were lower than the FCUs of healthy subjects (4.8% versus 6.9%; P < 0.0001).


The present studies indicate that the spot-FCU is a convenient, valid, and reliable indicator of the efficiency of the kidney in removing urate from the blood and thus from tissues. Spot-FCU determinations may provide useful correlates in studies investigating molecular mechanisms underpinning the observed range of efficiencies of the kidneys in clearing urate from the blood.

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