What is hyperuricemia?
Hyperuricemia is a high close of uric acid in the blood. The upper limit of normal is 6.8 mg/dL, and anything above 7 mg/dL is considered saturated and symptoms may appear. This elevated level is the result of increased production, decreased uric acid excretion, or a combination of both.
Elevated uric acid can also be seen in accelerated purine degradation, in states of high cell turnover (hemolysis, rhabdomyolysis, and tumor lysis), and decreased excretion (renal failure and metabolic acidosis). Hyperuricemia can lead to gout and nephrolithiasis. It has also been implicated as an indicator of diseases such as metabolic syndrome, diabetes mellitus, cardiovascular disease, and chronic kidney disease.
Causes of hyperuricemia
Uric acid is formed when purines are broken down in your body. Purines are chemicals found in certain foods. This generally includes:
- Red meat
- Organ meat
Normally, your body gets rid of uric acid when you urinate. Hyperuricemia occurs when your body makes too much uric acid or cannot excrete enough. It usually happens because the kidneys don’t remove it quickly enough.
Excess levels of uric acid in the blood can lead to the formation of crystals. Although they can form anywhere on the body, they tend to form in and around the joints and kidneys. Defensive white blood cells in your body can attack the crystals, causing inflammation and pain.
Symptoms of hyperuricemia
You may not have any symptoms.
- If your blood uric acid heights are significantly elevated and you are receiving chemotherapy for leukemia or lymphoma, you may have indications of kidney problems or gouty arthritis due to high blood uric acid levels.
- You may have fever, chills, fatigue if you have certain forms of cancer and your uric acid levels are high (caused by tumor lysis syndrome)
- You may notice inflammation of a joint (called “gout”) if uric acid crystals settle in one of your joints. (* Note: gout can also occur with normal uric acid levels).
- You may have kidney problems (caused by kidney stone formation) or trouble urinating.
Things you can do about hyperuricemia:
- Be sure to tell your doctor, as well as all health care providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).
- Remind your physician or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.
- Shadow your healthcare provider’s instructions regarding lowering your blood uric acid level and giving your hyperuricemia. If your blood levels are very high, you may be prescribed medicine to lower uric acid levels to a safe range.
- If you have a high uric acid level in your blood and your healthcare provider thinks you may be at risk for gout or kidney stones, try a low-purine diet.
High-purine foods include:
- All organ meats (such as liver), meat extracts, and sauce
- Yeasts and yeast excerpts (such as beer and alcoholic beverages)
- Asparagus, spinach, beans, peas, lentils, oatmeal, cauliflower, and mushrooms.
Low-purine foods include:
- Refined cereals: Bread, pasta, flour, tapioca, cakes
- Milk and dairy products, eggs
- Lettuce, tomato, vegetables
- Cream soups without meat broth
- Water, fruit juices, carbonated drinks.
- Peanut butter, fruit, and nuts
- Stay well hydrated, drinking 2 to 3 litres of water a day, unless instructed otherwise.
- Take all of your hyperuricemia medications as directed
- Avoid caffeine and alcohol, as they can contribute to uric acid problems and hyperuricemia.
Avoid medications, such as thiazide diuretics (hydrochlorothiazide) and loop diuretics (such as furosemide or Lasix®). Also, medications such as niacin and low doses of aspirin (less than 3 grams per day) can aggravate uric acid levels. Do not take these medications or aspirin unless you have been told to do so by a healthcare provider who knows your condition.
If you experience symptoms or side effects, especially if they are severe, be sure to discuss them with your healthcare team. They can prescribe medications and/or offer other suggestions that are effective in managing these problems.
Treatment of hyperuricemia
Hyperuricemia can be treated with changes in diet. Consuming less high-purine foods and drinks can lower uric acid in the blood. This reduction helps the kidneys to filter uric acid again more effectively.
Low-purine foods and drinks to consume instead include:
- Dairy products
- Whole grains
- Lean protein
Extra treatment may be essential when hyperuricemia leads to gout or kidney stones.
Doctors can prescribe medicine to treat episodes of gout. A doctor can prescribe non-steroidal anti-inflammatory drugs, such as ibuprofen. These will reduce inflammation and pain. Stronger medications include corticosteroids, such as prednisone, which also decrease inflammation. Colchicine is another medicine to treat inflammation with gout.
Treatment of kidney stones will depend on their size. Smaller kidney stones usually pass on their own. It is important to drink plenty of fluids and take pain relievers while the stones pass. Larger kidney stones may require removal. Doctors can use a variety of methods to remove kidney stones or help the body break them down. Shock wave lithotripsy, for example, involves blasting kidney stones with a sound wave. This treatment reduces them to lesser pieces, so they are easier to pass.
Diagnosis of hyperuricemia
Your doctor may order blood and urine tests to measure creatinine levels, which determine kidney function, as well as uric acid levels.
The blood is usually drawn from a vein in the arm, usually on the inside of the elbow or the back of the hand. Uric acid is normally found in urine as your body excretes it. Your doctor may order a 24-hour urine gathering if elevated levels of uric acid are found in your blood. This urine test is repeated after a purine-restricted diet, which helps determine if:
- Are eating too many high-purine foods
- Your body is manufacture too considerable uric acid
- Your body is not excreting enough uric acid
If you have symptoms of gout, your doctor will want to test for any fluid that has collected in your joints. This is done using a fine needle to remove fluid from the joint. It will be sent to a lab where it will be examined for any evidence of uric acid crystals. The presence of these crystals indicates gout.
Risk factors for hyperuricemia
Anyone can get hyperuricemia, but it is more common in men than women, and your risk increases with age. You are also more likely to get it if you have Pacific Islander heritage or are African American. Several risk factors are associated with hyperuricemia:
- Alcohol consumption
- Some medications, particularly medications for heart disease
- Lead exposure
- Exposure to pesticides
- High blood glucose levels
- Extreme levels of physical activity
Despite uric acid’s modest antioxidant activity, hyperuricemia is a potentially harmful condition. It favours the precipitation of uric acid crystals in joints and tissues, leading to complications such as gout, nephrolithiasis, and chronic kidney disease.