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Decreased renal clearance – (90% of patients) Intrinsic kidney disease heart disease causing decreased blood flow to the kidney drugs (loop diuretics, low dose aspirin, cyclosporin) genetic predisposition age related decrease in glomerulofiltration rate Increased uric acid synthesis Dietary indiscretions Genetic predisposition Increased tissue turnover–tumors, lymphoproliferative disorders Stress induced increased turnover of ATP Alcohol induced turnover of ATP All patients should be encouraged to modify their lifestyle including limiting alcohol intake, encouraging weight loss where appropriate and decreasing food rich in purines