Which diuretics may precipitate gout attacks?

Thiazide diuretics are associated with precipitating gout attacks because they can lead to a decrease in renal clearance of uric acid. Gout is a condition characterized by the accumulation of uric acid crystals in the joints, which causes inflammation and pain. When thiazide diuretics are administered, they can cause slight dehydration and reduced blood flow to the kidneys, which can in turn impair the kidney's ability to excrete uric acid effectively. As a result, serum uric acid levels can rise, potentially triggering a gout attack in susceptible individuals.

While loop diuretics are also known to have some effects on uric acid, they are generally less associated with precipitating gout attacks compared to thiazides. Potassium-sparing diuretics typically do not raise uric acid levels significantly, and carbonic anhydrase inhibitors are not commonly implicated in gout pathogenesis. Thus, thiazide diuretics are specifically noted for their impact on uric acid metabolism and their role in potentially triggering gout flares.