Moreover, high levels of insulin caused by insulin resistance stimulate Na+-H+ exchange in renal tubules, increase H+ excretion, and increase uric acid reabsorption35, while the activation of the renin-angiotensin system by hyperinsulinemia decreases renal blood flow, increases urate reabsorption, and produces xanthine oxidase, which then leads to an increase in uric acid production36, while McCormick et al. provided robust evidence that insulin resistance has a positive causal effect on serum urate concentrations37. This evidence concerns the gene REN and hyperinsulinism.