Paradoxical effects of pyrazinoate and nicotinate on urate transport in dog renal microvillus membranes

The effects of pyrazinoate and nicotinate on urate transport in microvillus membrane vesicles isolated from canine renal cortex were evaluated. An outwardly directed gradient of pyrazinoate stimulated uphill urate accumulation, suggesting urate-pyrazinoate exchange. An inside-alkaline pH gradient stimulated uphill pyrazinoate accumulation, which suggested pyrazinoate-OH^- exchange. Pyrazinoate-OH^- exchange and urate-OH^- exchange were similarly sensitive to inhibitors, implying that both processes occur via the same transport system. In addition, an inward Na⁺ gradient stimulated uphill pyrazinoate accumulation, suggesting Na⁺-pyrazinoate cotransport. Inhibitor studies demonstrated that Na⁺-pyrazinoate cotransport takes place via the same pathway that mediates Na⁺-lactate cotransport in these membrane vesicles. Previously we found that urate does not share this Na⁺-dependent cotransport pathway. Nicotinate inhibited transport of pyrazinoate by the anion exchange pathway and the Na⁺ cotransport pathway, suggesting that it is a substrate for both transport systems. Finally, in the presence of an inward Na⁺ gradient, low doses of pyrazinoate or nicotinate stimulated urate uptake, and higher doses of pyrazinoate or nicotinate inhibited urate accumulation, thereby mimicking in vitro the paradoxical effects of drugs on renal urate excretion that have been observed in vivo. These findings indicate that the paradoxical effect of uricosuric drugs at low doses to cause urate retention may result at least in part from stimulation of urate reabsorption across the luminal membrane of the proximal tubular cell.