To the Editor: The Clinical Practice review on gout by Mikuls (Nov. 17 issue)1 underscores the importance of hyperuricemia as a necessary risk factor and mentions the high heritability of serum urate levels.2 Serum urate levels are mostly controlled by the kidney, as confirmed by genetic studies implicating both rare and common variants in transporters and transcriptional regulators that mediate the tubular transport of urate.3,4 The latter can be assessed by the fractional excretion of urate, which is approximately 10% under normal conditions. The genetic influence on serum urate levels has clinical consequences. Patients with monogenic disorders such as autosomal . . .