Hyperuricemia

Hyperuricemia has already become one of the most common metabolic diseases in the world. Hyperuricemia is the medical term for having high uric acid levels in your body. Uric acid is an organic compound formed in the liver, secreted mainly by the kidneys and intestines. Uric acid is a waste product that’s created when your body breaks down chemicals called purines in food and drinks.

A standard uric acid level is under 6.8 milligrams per deciliter (mg/dL). A high uric acid level (above 6.8 mg/dL) is considered hyperuricemia. This can lead to gout and make your blood and urine too acidic.

Hyperuricemia is Very Common 

The prevalence of hyperuricemia has been increasing worldwide. The incidence is increasing worldwide as developing countries adopt more western diets and lifestyles. 

Up to 21% of the general population and 25% of hospitalized patients are estimated to have asymptomatic hyperuricemia, and uric acid levels can be elevated 10 to 15 years before clinical manifestations of gout. 

Most uric acid dissolves in your blood, passes through your kidneys and leaves your body in urine. Hyperuricemia is usually diagnosed after gout or kidney stones cause symptoms.

Uric acid and Oxidative Stress

Uric acid is recognized as a marker of oxidative stress. Serum uric acid concentration is a very important diagnostic and prognostic factor of many multifactorial disorders.

Research has also shown a link between high uric acid levels and other health conditions, including kidney disease, heart disease, high blood pressure, diabetes, fatty liver disease, obesity, metabolic syndrome, endothelial dysfunction, intracellular and mitochondrial oxidative stress, and stimulation of the intracellular renin angiotensin system, etc. which could pose a serious problem for public health.

Uric Acid Overproduction

Purines are substances that are found in some foods. Your body turns purines into uric acid. Purine-rich diet may cause hyperuricemia. Purine is present in alcohol (especially beer); beef; lamb; turkey; veal; venison; organ meats; and certain fish and shellfish (anchovies, cod, tuna, sardines, herring, mussels, shrimp, lobster, codfish, and scallops).

Drinking alcohol can cause dehydration and it can also trigger high uric acid levels. Alcohol increases the metabolism of nucleotides, another source of purines that can be turned into uric acid. It also affects the rate at which uric acid is secreted, leading to increased blood levels.

Usually, your body filters out uric acid through your kidneys and in urine. If you consume too much purine or if your body is unable to remove this by-product quickly enough, uric acid can build up in your blood.

Fructose causes hyperuricemia as its hepatic metabolism through the aldolase reductase pathway produces uric acid. Pure fructose and some products containing it, such as sugar, high-fructose corn syrup, and processed foods, are increasingly appearing on our tables. They seem to play a significant role in increasing uric acid synthesis in the body. High-fructose corn syrup and full-sugar sodas are especially harmful and are associated with obesity in children and adolescents.

Errors of purine metabolism can cause uric acid overproduction. Lesch-Nyhan syndrome (LNS) is a rare congenital (at birth) disorder that is a rare inherited disorder that results in both high levels of uric acid in the blood and urine, associated with severe gout and kidney problems. Children with LNS experience a severe, painful form of arthritis (gout (. They also have poor muscle control (dystonia) and mental disability. A key symptom is engaging in uncontrollable self-injury, including lip and finger biting or head banging.

High cell breakdown or turnover can cause uric acid overproduction. This can occur in lymphoproliferative diseases, myeloproliferative disease, polycythemia vera, psoriasis, tumor lysis, hemolysis, rhabdomyolysis, extreme exercise, and chemotherapy.

Decreased Uric Acid Excretion

Decreased uric acid excretion can occur with acute or chronic kidney disease, acidosis (e.g. lactic acidosis, ketoacidosis), hypovolemia, medication/toxins (diuretics, salicylates, lead, alcohol), sarcoidosis, hyperparathyroidism, hypothyroidism, and Down syndrome. 

Diuretic-induced Hyperuricemia

Thiazide and loop diuretics tend to cause a dose-dependent type of hyperuricemia and possibly even gout. They tend to increase renal uric acid reabsorption either directly or indirectly through volume depletion. The net increase in relative risk of gout by diuretics is almost 80%.

An alternate or concurrent antihypertensive is recommended in patients with gout flares. Most patients with diuretic-induced gout are treated with a xanthine oxidase inhibitor, such as allopurinol. 

Gout

Gout is a form of inflammatory arthritis that results from an excess of uric acid, or high levels of urate in the blood. Among people with gout, 90% have kidneys that don’t adequately remove uric acid from their urine, while 10% have high uric acid levels because they produce too much uric acid.

Very high levels of uric acid can form microscopic crystals that build up in the joints or under your skin (tophi). Eating a lot of certain foods increase uric acid levels—such as liver, kidney, herring, mussels, sardines, asparagus, and mushrooms.

If you have gout, then an injury, sickness, or having surgery can trigger attacks. Joint becomes warm, red, and swollen. Other symptoms include fever and feeling sick. 90% of gout attacks start in a single joint. Most often, it is the “bunion joint” of the big toe.

Other joints may also be affected at times, such as joints in the foot other than the big toe, ankle, knee, wrist, and elbow. Without treatment joint stiffness or joint damage may follow. Hard lumps can form under the skin around the joints. About 1 in 5 people with gout also get kidney stones, which cause pain and kidney problems.

Men get gout more than women by about three to one, but even more frequently than that before the age range during which women reach the menopause. Women are more likely to contract gout after they reach menopause. 

Untreated high uric acid levels can eventually lead to permanent damage in the bones, joints, tendons, and ligaments.

Gout is Partly Genetic

Both genetic and environmental factors contribute to the condition. Specifically, the genetic factors affect your body’s ability to excrete urine. Gout is partly genetic. In other words, if you have a relative with gout, it may be passed on to you.

The condition involves genes that control urate transporters. Urate transporters regulate urate excretion. If one of these urate-related genes has a variation, it may lead to gout. What’s more, there are dozens of potential gene variations, and it’s possible to have more than one.

The heritability of gout is 65 percent. Heritability is the measurement of a genetic influence. Overall, it’s estimated that 20 percent of people with gout have a relative with the condition. Your risk is higher if it’s a first degree relative, such as a sibling or a parent.

Hyperuricemia Risk Factors

Hyperuricemia can affect anyone. Some groups of people are more likely to develop hyperuricemia, including people who were assigned male at birth, have obesity, regularly drink alcohol, regularly eat high-purine foods, have family members with hyperuricemia or gout, or have hypothyroidism.

Prevention Tips

The best way to prevent hyperuricemia is by following a diet and exercise plan that’s healthy for you. Limiting how often you eat or drink foods and beverages high in purines will help you keep your uric acid levels low. It will also help you maintain good overall health. Reduce your intake of purine-rich foods, such as red meat, organ meats, fish, shellfish, and poultry.

Limit fructose. Fructose in beverages is absorbed quicker than sugars in whole foods because beverages don’t contain fiber, protein, or other nutrients. Eat more whole foods, limit processed, packaged foods, check food labels for added sugars, quench sugar cravings with fresh fruit, replace sugary drinks with water, or unsweetened drinks.

Drinking more water can reduce the frequency of acute gout. Drinking plenty of fluids helps your kidneys flush out uric acid faster. The kidneys filter out about 70% of the uric acid in your body. Drinking enough water can help support your kidneys and may reduce your risk of uric acid kidney stones.

Manage weight. More weight may cause your kidneys to work less efficiently. It can also increase uric acid production and decrease the excretion of uric acid through urine.

Manage blood sugar. Hyperuricemia is linked to the development of diabetes and related complications.

Add more fiber to your diet. Eating more fiber can help reduce uric acid levels. Include plenty of vegetables with meals, either as a side dish or added to sauces, stews, or curries. Have some fresh or dried fruit, or fruit canned in natural juice for dessert.

Boost vitamin C intake. High vitamin C intake can help lower uric acid levels. High vitamin C foods include guavas, bell peppers, kiwifruit, strawberries, oranges, papayas, broccoli, and tomatoes.

Check your medications and supplements. Some medications and supplements can increase uric acid levels. These include aspirin, diuretics, immune-suppressing drugs, such tacrolimus, and some blood pressure medications.