Hyperuricemia and Kidney Disease

Urine and blood samples
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When we urinate, our bodies eliminate liquid waste consisting of water and salt as well as the chemicals urea and uric acid. Most uric acid is produced naturally in the body; the rest is converted from substances in certain foods, called purines. If uric acid levels are too high, they can cause a condition known as hyperuricemia, a risk factor for both gout and kidney disease.

Serum Urate Levels

Most uric acid dissolves in the blood, then travels to the kidneys to be excreted in urine. Normally, women maintain a stable serum urate level between 1.5 to 6.0 mg/dL in women, while for men it is between 2.5 to 7.0 mg/dL.If you produce too much uric acid or are unable to eliminate enough of it, you may have elevated serum urate levels, which can lead to hyperuricemia.

A blood test is one way to check your uric acid level; it can also be checked using a urine sample. Ideally, your serum uric acid level should be 6.0 mg/dl or lower. A uric acid level of 6.8 mg/dl or higher indicates hyperuricemia.

Causes and Risk Factors

Aging and being male put you at a higher risk of developing hyperuricemia. Some studies have found that African Americans, and Maori and Filipino populations are at a higher risk.Other risk factors include:

  • Renal insufficiency
  • Metabolic syndrome—a disorder that involves obesity, abnormal blood pressure, dysglycemia (blood sugar disorders), dyslipidemia (lipid disorders)
  • A diet that is high in alcohol, purines, protein, and carbohydrates
  • Medications, including thiazides, loop diuretics, and low-dose aspirin
  • Niacin
  • Acidosis
  • Chemotherapy
  • Diabetes
  • Hypoparathyroidism
  • Psoriasis
  • Lead poisoning
  • Polycythemia vera
  • Toxemia related to pregnancy
  • Tumor lysis syndrome
  • Genetic predisposition

Symptoms and Complications

While hyperuricemia itself is not a disease—and in some cases causes no symptoms or problems—a prolonged state of this condition may lead to the development of uric acid crystals, which can be problematic.

The two most common conditions that can result from high uric acid levels are gout and kidney disease. With gout, uric acid crystals build up in the joints, promoting inflammation and the breakdown of joint cartilage. Symptoms include pain, swelling, redness, stiffness, deformity, inflammation, and limited range of motion.

Uric acid crystals can also be deposited in the kidneys, causing kidney stones to form. These stones can be very painful and, if left untreated, can block the urinary tract and cause infections. Symptoms of kidney stones include:

  • Pain or aching in your lower back, side, abdomen, or groin
  • Nausea
  • Increased urge to urinate
  • Pain when urinating
  • Difficulty urinating
  • Blood in your urine
  • Foul-smelling or cloudy urine.

Kidney stones can also cause urinary tract infections (UTIs) because they harbor bacteria. The symptoms of a UTI can include any or all of the above; fever or chills can also be present.

Over time, kidney stones and other forms of kidney damage can lead to chronic kidney disease, which makes it more difficult to get rid of uric acid. Untreated kidney disease can ultimately lead to kidney failure or loss of kidney function.

Treatment

If you're not having symptoms, you don't necessarily require treatment for hyperuricemia. When symptoms are present, a diet low in some non-plant based purines may help regulate uric acid levels. If that is not effective, your doctor may prescribe a medication to control your levels.

High in Purines

  • Organ meats, meat extracts, and gravy

  • Sardines, anchovies, shellfish, and tuna

  • Beer and other alcoholic beverages

  • Sugary foods and beverages (such as soda) that contain high-fructose corn syrup

Low in Purines

  • Milk and milk products

  • Eggs

  • Lettuce, tomatoes, and green vegetables

  • Cream soups without meat stock

  • Peanut butter and nuts

  • Citrus fruits

It's also important to drink at least 8 ounces of water a day to help the kidneys flush out uric acid. Some studies suggest that drinking coffee on a regular basis can prevent the development of gout.

When dietary changes do not sufficiently control hyperuricemia, your doctor may prescribe medications to keep uric acid levels under control. These include:

  • Benemid (probenecid): Known as a uricosuric medication, this drug blocks the reabsorption of urate to prevent crystals from depositing.
  • Zyloprin (allopurinol), Uloric (febuxostat): These xanthine oxidase inhibitors (XOIs) reduce the body’s production of uric acid.
  • Zurampic (lenisurad) is prescribed with an XOI to increase its effects.
  • Krystexxa (pegloticase): Pegloticase is given by intravenous infusion. It changes uric acid into a substance called allantoin that your body can eliminate easily. It is reserved for people for whom other gout medications have not worked.

A Word From Verywell

It is important to know your uric acid level, just as it is important to know your cholesterol or blood glucose levels. Talk to your doctor if you are experiencing sore joints or frequent urinary tract infections. If you've had attacks of gout, you should have your uric acid levels tested every six months to ensure that they remain under 6.0 mg/dl.

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Article Sources

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Additional Reading

  • Purine and Pyrimidine Metabolism. Diffen.

  • About Uric Acid. Gout & Uric Acid Education Society.

  • Arthritis Foundation. Gout Diet: Do's and Dont's.

  • Uric Acid - Blood. MedlinePlus.

  • Kelley's Textbook of Rheumatology. Ninth edition. Elsevier. Chapter 94: Etiology and Pathogenesis of Hyperuricemia and Gout.