The conventional approach of preventing future gout attacks is to lower the uric acid levels. Logically speaking, that approach is right because gout is the result of acute inflammation caused by the formation of monosodium urate crystals due high concentration of uric acid level. By lowering down the high uric acid (hyperuricemia) and bring it back to the healthy range, it can prevent the occurrence of future gout attacks. 

But current medical world has missed out one very important perspective, which is that difference between the uric acid distribution between blood serum and interstitial fluid (including synovial fluids). Currently there isn’t any technology available to measure the uric acid concentration in the interstitial or synovial fluid. Thus, the only empirical reference of uric acid level is the serum uric acid of the blood test. This because scientists assume that the blood serum has same properties with other body fluids. Sadly, it is not so in real living human. The distribution of uric acid in the body is unpredictable, kindly refer to the Gout Black Box Theory in my book. 

That fundamental concept will help you understand how does lesinurad work or why the pharmacology scientists want it to work in such away. Current medical approach towards treating hyperuricemia is merely focusing on lowering the uric acid level in the blood serum, because that’s the only data source they have in uric acid level monitoring. 

To achieve that objective, there are 2 approaches – upstream suppression and downstream promotion. Upstream suppression is achieved through the use of xanthine oxidase inhibitor, such as allopurinol and febuxostat. Lesinurad is under the category of downstream promotion. Lesinurad is classified as uricosuric agent, it’s function is to prevent the reabsorption of uric acid in the kidney tubules. In order to grasp a clearer picture on how does lesinurad work (and the formation of it’s side effects), you need to first understand how the kidneys filter the blood and produces urine. The best and easiest way to watch the following short clip.  

Now you understand that there’s a reabsorption process happening in the nephrons filter your blood. Lesinurad works by suppressing one particular protein – URAT1 which is the carrier that help to transport the uric acid back in to the blood stream. The end result is that lesinurad increase the excretion of uric acid in the urine, that’s why it is known to have uricosuric effect. 

 

Naturally, your body knows how to balance out the urine concentration by inducing thirst so that you drink more water when the urine concentration is high, this is to prevent the formation of kidney stones. Long term consumption of lesinurad disrupt the kidney’s natural ability to maintain the osmosis balance that thus increases the risk of renal side effects such as increase creatinine level and formation of kidney stones. 

Usually lesinurad is prescribed together with xanthine oxidase inhibitor to produce significant result. This approach is like temporarily “hollow” out the uric acid in the blood serum, but the downside is that it creates some sort of dependency towards the medicines. Very often I heard my clients told me they that experienced spike of uric acid or gout attacks as soon as they stop the medication. 

Instead of disrupting the natural functions of the organs, one should consider a more holistic approach towards rebalancing flushing the excessive uric acid from the body with the help of Calkaline as mention in The Cure.