Question:medium
Which of the following is the underlying metabolic basis of acute gout?
Which of the following is the underlying metabolic basis of acute gout?
Show Hint
Think which biochemical change actually drives crystal deposition; xanthine oxidase makes urate, it does not remove it.
Updated On: Jun 23, 2026
- Uric acid nephrolithiasis
- Deficiency of enzyme xanthine oxidase
- Increase in serum urate concentration
- Renal disease involving interstitial tissues
Show Solution
The Correct Option is C
Solution and Explanation
Step 1: Begin with the chemistry. Purines are broken down through hypoxanthine and xanthine to uric acid, a reaction catalysed by xanthine oxidase. Gout appears when the body either makes too much urate or clears too little of it. Step 2: The defining laboratory feature and the true engine of the disease is a high serum urate level, written as $[\text{urate}]_{serum} > 6.8\ mg/dL$, the saturation point. Past this point urate precipitates as monosodium urate crystals. Step 3: Those crystals are phagocytosed by neutrophils, which release inflammatory mediators and cause the painful acute attack. Hence the metabolic root is the elevated urate concentration, option c. Step 4: Reject the distractors: blocking xanthine oxidase (option b) is the basis of allopurinol THERAPY and would drop urate, not cause gout; stones (option a) and interstitial nephropathy (option d) are downstream consequences. The printed key (b) is medically wrong. \[\boxed{\text{Increase in serum urate concentration}}\]
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