Hyperuricemia is when you have too much uric acid in your blood. This condition can lead to health problems such as gout and kidney stones.
Around one out of every five people has a high uric acid level. Read on to learn more about hyperuricemia, its symptoms, how to treat it, and more.
Causes of Hyperuricemia
Hyperuricemia refers to a high uric acid level in your blood. Uric acid is created when purines, which are chemical compounds that are found in certain foods and can be made by your body, break down.
For a long time, people assumed that hyperuricemia was the same as gout, a disease that affects your joints. But we now know that when you have hyperuricemia, it may or may not result in gout. In fact, most people with high uric acid levels don’t have any symptoms at all.
Hyperuricemia can occur as a result of your body producing too much uric acid or getting rid of too little.
You may be producing too much uric acid if:
- You have a purine-rich diet. Foods high in purine include some organ meats, game, herrings and a few other types of seafood, and beer.
- Your body's cells break down due to exercise and certain other conditions.
- Your body naturally makes too many purines.
You may not be able to release enough uric acid from your body if:
- Your kidneys aren’t functioning as well as they should.
- Acids and bases in your body are out of balance.
- You have Down syndrome.
- You have hypothyroidism.
- You’re taking certain medications: beryllium, cyclosporin, diuretics, ethambutol, and niacin.
- You have toxins such as lead and alcohol in your body.
If you are overweight, you are also at risk for hyperuricemia. In overweight children and adolescents, hyperuricemia is often accompanied by elements of metabolic syndrome: insulin resistance and high blood pressure.
Symptoms of Hyperuricemia
Most people with hyperuricemia have no symptoms and don’t require long-term therapy.
According to research, around 21 percent of the general population and 25 percent of people in hospitals have asymptomatic hyperuricemia, which means they don’t have symptoms. Of the general U.S. population, 3.9 percent have gout, the most common complication of hyperuricemia. This is a disorder where uric acid builds up in the tissues and blood and leads to painful joints, particularly in your big toe.
Another common symptom of hyperuricemia is the formation of kidney stones, which can lead to sharp pain in the abdomen or side, nausea, and vomiting.
Testing for hyperuricemia is not routine in asymptomatic individuals because it is not clear that it will change management. Your doctor will most likely test you for hyperuricemia if you’re showing signs of gout or kidney stones. They will likely make use of physical examinations, lab studies, and ultrasounds.
Physical examination. If you have gout, you’ll have a swollen and warm joint. Gout usually affects the big toe, but it can affect any joint in your body and typically affects one joint at a time. If you have kidney stones, this can be asymptomatic (found on imaging studies only) or can be symptomatic with flank or abdominal pain.
Lab studies. Your doctor may order bloodwork to test for your level of uric acid. They may also want to see what they'll refer to as a complete blood count (CBC), lipid profile, comprehensive metabolic panel (CMP), and calcium and phosphate levels to get a better understanding of what may be raising your level of uric acid.
Your doctor may ask you to collect your urine over a 24-hour period to test for its quantity of uric acid. Your gender, age, and diet may affect the diagnosis.
Kidney ultrasound. Your doctor may suggest that you get a kidney ultrasound if you have kidney stones or symptoms that suggest you have stones.
Your doctor may prescribe a uric acid level–lowering medication such as:
- Probenecid, for gout and to slow down your production of uric acid
- Rasburicase, which converts uric acid to something that your kidneys can rid of more easily (this is only prescribed in inpatient settings, usually in the setting of tumor lysis syndrome - see below)
- Allopurinol, which is used to treat gouty arthritis, kidney stones, and chemotherapy-related hyperuricemia
If you are undergoing chemotherapy and have a high uric acid level but no related symptoms, your doctor may still recommend medication to lower the level. They may want to protect you from a serious condition called tumor lysis syndrome.
If you have gout or kidney stones, you may need monitoring to see if your condition is improving with treatment.
Since there are many causes of hyperuricemia, and if treatment is recommended, you may benefit from a team of medical professionals, which may include:
- An endocrinologist, or doctor specializing in glands and hormones
- A rheumatologist, or doctor specializing in tendons, joints, bones, ligaments, and muscles
- A nurse
- Your primary care provider
- A dietician
- A nephrologist (doctor who specializes in kidney diseases, including kidney stones)
Talk to your primary care physician about other providers who may be able to help.