A high uric acid level, or hyperuricemia, is an excess of uric acid in your blood. Uric acid is produced during the breakdown of purines, which are found in certain foods and are also formed by your body.
Once produced, uric acid is carried in your blood and passes through your kidneys, where most of it is filtered out into the urine.
About one in five people has a high uric acid level. It may be related to attacks of gout or the development of kidney stones. But most people with high uric acid levels don’t have any symptoms or related problems.
What Causes Hyperuricemia?
Causes of high uric acid levels (hyperuricemia) can be primary (increased uric acid levels due to purine), and secondary (high uric acid levels due to another disease or condition). Sometimes, the body produces more uric acid than it is able to excrete.
Causes of high uric acid levels include:
- Primary hyperuricemia
- Increased production of uric acid from purine
- Your kidneys cannot get rid of the uric acid in your blood, resulting in high levels
- Secondary hyperuricemia
- Certain cancers, or chemotherapy agents may cause an increased turnover rate of cell death. This is usually due to chemotherapy, but high uric acid levels can occur before chemotherapy is administered.
- After chemotherapy, there is often a rapid amount of cellular destruction, and tumor lysis syndrome may occur. You may be at risk for tumor lysis syndrome if you receive chemotherapy for certain types of leukemia, lymphoma, or multiple myeloma, if there is a large amount of disease present.
- Kidney disease – this may cause you to not be able to clear the uric acid out of your system, thus causing hyperuricemia.
- Medications – can cause increased levels of uric acid in the blood
- Endocrine or metabolic conditions -certain forms of diabetes, or acidosis can cause hyperuricemia
- Elevated uric acid levels may produce kidney problems, or none at all. People may live many years with elevated uric acid levels, and they do not develop gout or gouty arthritis (arthritis means “joint inflammation”). Only about 20% of people with elevated uric acid levels ever develop gout, and some people with gout do not have significantly elevated uric acid levels in their blood.
High Uric Acid Symptoms
Increased uric acid levels may go undiagnosed because some people may be asymptomatic. However, some people with high uric acid levels may experience symptoms due to the effects of the excessive uric acid on their bodies. For example, hyperuricemia can lead to gout (inflammation of the joints) and kidney ailments such as kidney stones and kidney failure. These medical conditions are explored in detail below.
- Gout develops due to an immunologic reaction to the accumulation of uric acid crystals in the joints. Gout is characterized by extreme pain in the joint that worsens in response to minimal pressure, inflammation (swelling, warmth, and tenderness) of the joint, fever, and peeling of the skin around the joint. Uric acid levels exceeding 10mg/dL increases the risk of developing gout.
- Kidney stones may develop in people suffering with high uric acid levels, and these kidney stones may go unnoticed until they become stuck in the ureter causing immense pain, painful and more frequent urination, bloody urine, or nausea and vomiting. Approximately 10% of the kidney stones that are detected in the United States are composed of uric acid. Although uric acid kidney stones are commonly found in gout patients, they are also detected in approximately 20% of patients have high uric acid levels but not gout. The classic symptoms of kidney stones are sudden and intense pain in the abdomen, flank, and groin region, which tends to come in waves. Additional symptoms include bloody urine and painful urination, and if there is a secondary infection a fever may be detected.
- Kidney failure. The most severe symptom associated with high uric acid levels is kidney failure, which manifests as decreased urination, shortness of breath, swelling in the limbs, confusion and drowsiness, fatigue, or chest pain. Kidney failure can develop in patients with leukemia, Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma due to uric acid levels. This is usually a consequence of chemotherapy, which kills off malignant cells and releases uric acid along with their inner contents.
- Other diseases. Although recent research has suggested that high uric acid levels are linked to hypertension and heart disease, it remains to be determined whether reducing uric acid levels would reverse these conditions.
Treatments for High Uric Acid
If you are diagnosed with hyperuricemia your doctor will likely advise dietary changes and/or prescribe medications that either treat the underlying disease that may be contributing to the high uric acid levels or that directly regulate the body’s metabolism.
- Diet: High uric acid levels can occur as a result of eating a diet that is rich in purines. Therefore, reducing the intake of these foods can lower the uric acid levels. You should avoid foods that are rich in protein and alkaloids, as well as fried foods and white sugar. Interestingly, dietary changes may also be effective in cases of elevated uric acid levels that are unrelated to diet. Eating fruits such as strawberries and drinking black cherry juice may help to lower uric acid levels.
- Drug Treatments: In cases of chronic high uric acid levels, the best treatment option is medications that block the body’s ability to make or absorb uric acid or that enhance the body’s ability to excrete uric acid.For example, the drug Probenecidblocks the absorption of urates. On the other hand, the drugs Allupurinol, febuxostate and sulfinpyrazone, block the production of uric acid and/or enhance the excretion of uric acid.
High uric acid levels usually occurs secondary to some other conditions. If an underlying condition is responsible for the high uric acid levels, then remedying that condition is the best treatment strategy. In the event that the underlying condition is untreatable and there is chronic elevation of the uric acid levels, the best treatment option is to target the metabolism of purine.
Notes: Typically, hyperuricemia is uncovered during testing to diagnose some other condition. If high uric acid levels are detected, your doctor may suggest additional tests to better understand your condition and clarify your diagnosis. A better understanding of the underlying conditions that may be contributing to your elevated uric acid levels will help your doctor devise the best treatment regimen. It is important to remember that even if you believe that your current medications may be contributing to your high uric acid levels, you should not stop taking them without consulting your doctor.