Hyperuricemia and Uric Acid Levels: All You Need to Know

Medically Reviewed By Jenneh Rishe, RN

Hyperuricemia is when the blood has elevated levels of uric acid, also known as urate. Uric acid is a byproduct of the liver. Too much uric acid can result from increased production of uric acid in the body, insufficient excretion of the uric acid through urine, or both. Hyperuricemia is relatively common in the general population. Researchers estimate that as much as 21% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  of the general population experience the condition.

Most cases are asymptomatic, meaning they do not present obvious symptoms to the individual. However, elevated uric acid is detectable using blood tests and can cause other symptoms. Additionally, hyperuricemia can lead to complications to health, such as gout and uric acid nephrolithiasis.

This article will review what hyperuricemia is, its symptoms and related conditions, and how clinicians diagnose and treat it.

What causes hyperuricemia?

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The liver and intestines produce uric acid after breaking down purines, which are natural components of food and the body’s cells. Typically, the kidney then excretes the uric acid through urine.

Hyperuricemia happens when there is increased production of uric acid in the body or decreased excretion of the acid as a waste product. This imbalance causes elevated levels.

Consuming foods rich in purine can accelerate the production of uric acid in the body. Certain medical conditions can also increase purine levels, which may lead to more uric acid production. Alternatively, some conditions affect the ability to excrete uric acid properly, allowing the uric acid to elevate and accumulate.

Causes of hyperuricemia due to overproduction of uric acid can include:

  • a diet rich in purines, for example, high in foods such as:
    • meat, particularly game meat and organ meats
    • seafood
    • alcohol
  • conditions that affect cell breakdown and turnover, such as:
    • lymphoproliferative and myeloproliferative diseases, conditions that affect the bone marrow and blood cells, such as leukemia and polycythemia vera

Causes of hyperuricemia due to insufficient excretion of uric acid as a waste product include:

Risk factors

People who experience certain conditions may be more at risk than others for developing hyperuricemia. These factors can include certain underlying conditions, some diet and lifestyle habits, and differences in blood health.

Risk factors for hyperuricemia may include:

People of certain ages and sexes may also be more likely to experience gout. For example, males (sex assigned at birth) and older people experience gout more frequently Trusted Source International Journal of Obesity Peer reviewed journal Go to source .

Signs and symptoms of hyperuricemia

Sometimes, people with hyperuricemia show no symptoms at all.

However, the person may experience symptoms if the hyperuricemia is severe. They may also experience symptoms if it has progressed to gout, uric acid nephrolithiasis, or other complications.

Symptoms of the progression or complication of high uric acid levels include:

  • a tender, hot, or swollen joint
  • a joint that appears flushed or that has shiny skin
  • severe pain in at least one joint
  • difficulty moving the joint
  • difficulty or pain when urinating, or blood in urine
  • symptoms of having uric acid stones, which include:
    • severe pain in the lower back
    • pain in the side of the abdomen that does not relieve
    • nausea or vomiting
    • fever or chills
    • urine that has an odor or appears cloudy

Gout may particularly affect joints of the limbs, but it can occur anywhere.

Contact your doctor regarding any new or persistent symptoms, including symptoms of pain, inflammation, or blood in the urine.

Uric acid levels

Blood tests can detect high levels of uric acid.

In adults, expected blood uric acid levels are 6.8 milligrams per decilitre (mg/dL).

Clinicians consider any result above these levels to be saturated, and symptoms can occur.

Long-term therapy may not be necessary for people with elevated uric acid levels with no symptoms. However, if you have clinical manifestations of hyperuricemia, your doctor may order additional blood tests and imaging tests to evaluate your symptoms and prescribe treatment. These clinical manifestations can include gout and uric acid nephrolithiasis.

Diagnosis and testing

Clinicians do not necessarily recommend routine screening for hyperuricemia. However, doctors will order certain tests if you are experiencing signs and symptoms of hyperuricemia or related conditions.

Tests that can indicate the progression of hyperuricemia can include:

  • low urine pH, or acidic urine
  • 24-hour urine uric acid collection after eating a purine-free diet
  • blood tests to examine a variety of factors, such as:
  • X-rays of any affected joints
  • ultrasound scans of the kidneys
  • joint aspiration

Treatment for hyperuricemia

As many people with hyperuricemia do not experience symptoms, they may not need medical treatment.

However, doctors may recommend treatment for people with symptoms, those with other underlying conditions, and those undergoing certain cancer therapies.

In such cases, doctors can prescribe urate-lowering medications. These can include:

Doctors may also recommend additional treatment options to help manage further symptoms if you experience complications of hyperuricemia. For example, gout treatment can include nonsteroidal anti-inflammatory medications (NSAIDs).

Complications of hyperuricemia

Complications of hyperuricemia can include:

  • gout
  • uric acid nephrolithiasis, which affects the renal system
  • urinary or kidney stones, which occur when uric acid builds up and forms crystals

However, not everyone will experience complications from hyperuricemia.

Hyperuricemia and gout

Gout occurs when uric acid builds up and forms uric acid crystals. These crystals can accumulate in the body’s tissues, fluids, and joints. This buildup can cause the affected tissues and joints to be flushed, swollen, painful, or difficult to move.

Not all people with hyperuricemia will develop gout. Uric acid levels can be elevated for 10–15 years Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source before the person starts seeing symptoms of gout.

FAQ

Below are some frequently asked questions about hyperuricemia.

Is hyperuricemia the same as gout?

Hyperuricemia is not the same as gout. However, gout can develop as a complication of hyperuricemia.

Hyperuricemia means a high level of uric acid or urate in the body. Gout refers to when this uric acid accumulates and forms crystals. These crystals can build up in the joints and other tissues of the body.

If you have hyperuricemia but do not have symptoms of gout, you may not need any treatment.

What is the most common cause of hyperuricemia?

Common causes Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of hyperuricemia are when your body makes too much uric acid or excretes too little uric acid through urine.

Examples of causes of the overproduction and under-excretion of uric acid include eating a diet high in meat, seafood, or alcohol. Underlying conditions affecting the kidneys or cell turnover can also cause hyperuricemia.

Summary

Hyperuricemia refers to elevated levels of uric acid, or urate, in the body. It occurs when your body makes too much uric acid or excretes too little.

Most people with hyperuricemia have no symptoms, and the condition is relatively common in the general population. Clinicians may instead be able to detect high uric acid levels through blood tests.

The most common complication of hyperuricemia is gout, which causes swollen, painful joints.

If you have no symptoms of hyperuricemia, you may not need treatment. However, if you develop complications, your doctor can prescribe urate-lowering medication. This will help to relieve symptoms of hyperuricemia.

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Medical Reviewer: Jenneh Rishe, RN
Last Review Date: 2022 Jun 30
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