Definition

What is hyperuricemia?

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.

How common is hyperuricemia?

About one in five people has a high uric acid level. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of hyperuricemia?

Only about one-third of people with hyperuricemia experience symptoms. This is known as asymptomatic hyperuricemia.

Although hyperuricemia isn’t a disease, if uric acid levels remain high, over time they can lead to several diseases.

Gout

Gout, sometimes called gouty arthritis, occurs in about 20 percent of people with hyperuricemia. A rapid drop in uric acid levels can also trigger gout. Gout can appear as isolated attacks, or flares. Some people experience chronic gout, which involves a number attacks occurring over short periods of time.

Gout can affect any joint in your body, but flares often first appear in your large toe. Feet, ankles, knees, and elbows are also common sites of gout.

Gout attacks tend to occur suddenly, often at night. The attacks peak in intensity in about 12 to 14 hours. Even untreated, attacks of gout usually subside within two weeks.

Symptoms of gout may include:

  • Severe pain in your joints
  • Joint stiffness
  • Difficulty moving affected joints
  • Redness and swelling
  • Misshapen joints

Tophaceous gout

If you’ve had hyperuricemia for several years, uric acid crystals can form clumps called tophi. These hard lumps are found under your skin, around your joints, and in the curve at the top of your ear. Tophi can worsen joint pain and over time damage your joints or compress your nerves. They’re often visible to the eye and can become disfiguring.

Kidney stones

Uric acid crystals can cause a buildup of stones in your kidneys. Often, the stones are small and are passed in your urine. Sometimes, they can become too large to pass and block parts of your urinary tract.

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 urine

If you also have a kidney infection, you may experience fever or chills.

This buildup of urine is an ideal breeding zone for bacteria. As a result, urinary tract infections are common when you have kidney stones.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes hyperuricemia?

Most of the time, a high uric acid level occurs when your kidneys don’t eliminate uric acid efficiently. Things that may cause this slow-down in the removal of uric acid include rich foods, being overweight, having diabetes, taking certain diuretics (sometimes called water pills) and drinking too much alcohol. Other less common causes are a diet high in purine-containing items or your body producing too much uric acid.

Risk factors

What increases my risk for hyperuricemia?

There are many risk factors for hyperuricemia, such as:

  • Diuretic medications (water pills)
  • Drinking too much alcohol
  • Genetics (inherited tendencies)
  • Hypothyroidism (underactive thyroid)
  • Immune-suppressing drugs
  • Niacin, or vitamin B-3
  • Obesity
  • Psoriasis
  • Purine-rich diet — liver, game meat, anchovies, sardines, gravy, dried beans and peas, mushrooms, and other foods
  • Renal insufficiency — inability of the kidneys to filter waste
  • Tumor lysis syndrome — a rapid release of cells into the blood caused by certain cancers or by chemotherapy for those cancers

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is hyperuricemia diagnosed?

Your doctor may order blood and urine tests to measure creatinine levels, which determines kidney function, as well as uric acid levels.

Blood is usually taken from a vein in your arm, typically on the inside of your elbow or on the back of your hand. Uric acid is normally found in your urine as your body excretes it. Your doctor may order a 24-hour urine collection if elevated levels of uric acid are found in your blood.

This urine test is then repeated after a purine-restricted diet, which helps in determining whether:

  • You’re eating too much high-purine foods
  • Your body is making too much uric acid
  • Your body isn’t excreting enough uric acid

If you’re experiencing symptoms of gout, your doctor will want to test any fluid that has built up in your joints. This is done by using a fine needle to draw fluid from the joint. It will be sent to a lab where it’ll be examined for any evidence of uric acid crystals. The presence of these crystals indicates gout.

How is hyperuricemia treated?

Your treatment for hyperuricemia will depend on its cause. If your hyperuricemia is asymptomatic, treatment isn’t recommended. In this situation, there isn’t any proven benefit to administering uric acid lowering therapies.

If your hyperuricemia is tied to an underlying condition, the condition will need to be treated:

Gout

Gout is treated with one or more of the following medications:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can help prevent or reduce the severity of gout. These include ibuprofen (Advil, Motrin IB), naproxen (Aleve, Naprosyn), and celecoxib (Celebrex),
  • Colchicine (Colcrys) is often used to prevent or treat gout, particularly for people who don’t tolerate NSAIDs well.
  • Probenecid helps lower uric acid levels by increasing urination and is used to help prevent gout attacks.
  • Allopurinol (Zyloprim) and febuxostat (Uloric) help prevent gout by reducing the amount of uric acid in your bloodstream.

Treatment for tophaceous gout is the same as for gout. If tophi become so large that they interfere with joint movement, damage surrounding tissue, or protrude through your skin, they may need to be surgically removed.

During this procedure, an incision is made in skin overlying a tophus, and the tophus is removed. In rare instances of joint damage, joint replacement surgery may be considered.

Kidney stones

If you have kidney stones smaller than 5 millimeters (mm), your doctor may advise you to drink a lot of water and take over-the-counter pain medications until the stones pass.

Kidney stones that are 5 mm or larger are less likely to pass on their own. Some doctors prescribe medications such as tamsulosin (Flomax) to relax the muscles in your urinary tract. This can make it easier and less painful to pass the stones.

Additional techniques may be required. Extracorporeal show wave lithotripsy is a noninvasive procedure where ultrasonic energy or shock waves are directed through your skin at the kidney stone. The shock waves break the large stone into smaller pieces that can pass more easily through your urinary system.

If the stones are greater than 10 mm, you may need to have them surgically removed.

Ureteroscopic surgery is performed by passing a 2 mm scope through your urethra. It goes through your bladder and directly into the ureters, which are the tubes connecting your kidneys to your bladder.

Your surgeon can then perform stone extraction. If the stones must be fragmented first, stents may be placed to aid the flow of urine. This can help relieve pain and keep the ureters dilated to allow for easier passage of fragmented or dissolving stones.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage hyperuricemia?

The following lifestyles and home remedies might help you cope with hyperuricemia:

Certain dietary changes may help decrease the level of uric acid in your blood. If your hyperuricemia is tied to gout, dietary changes may lower your risk of gout attack and slow the progression of any joint damage.

If you think switching up your diet could be beneficial, consult your doctor. They can help you determine if this is the best choice for you.

If you do adjust your diet, you should continue to follow your doctor-recommended treatment regimen. Dietary changes shouldn’t be used as a first-line treatment.

Remember that uric acid is formed when purines break down in your body. Although purine occurs naturally, it’s also present in certain foods. Avoiding these foods may be beneficial.

In addition to reducing purines, you should drink more fluids, especially water. Staying hydrated has been tied to fewer gout attacks. A general rule of thumb is to drink eight 8-ounce glasses of liquid each day. Talk with your doctor about how much you should drink.

You should also exercise regularly and maintain a healthy weight. Your doctor can make specific recommendations that best suit your needs.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: December 27, 2017 | Last Modified: December 27, 2017

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