The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.
Uric acid is a waste product formed by the breakdown of purines. Purines are vital components in our DNA and coenzymes, and are both produced in our body and also obtained by eating foods that are rich in purine. Uric acid is mostly secreted in the urine, keeping our blood concentration of uric acid within a tight range. The normal ranges of serum uric acid is 2.7-6.1 mg/dL (female adults) and 3.7-8.0 mg/dL (male adults).
The Importance of Tracking Your Uric Acid levels
Uric acid levels in your blood can be elevated above normal (hyperuricemia). Your doctor may track this biomarker to detect presence of gout (joint pain from uric acid deposit in the joint), to monitor uric acid levels when undergoing chemo- or radiotherapy; to detect high levels of uric acid in your urine to diagnose kidney stones caused by uric acid crystal deposits (in the kidneys), or to monitor people with gout to see if they are likely to develop kidney stones.
Signs and Symptoms of Uric Acid Abnormalities
Hyperuricemia causes characteristic signs and symptoms which once experienced, never forgotten. People almost always know when another attack of hyperuricemia is happening. The prevalence rate of hyperuricemia is estimated at 20% to 25%.
These signs and symptoms include:
- Inflammation of the joints (gout) with joint pain and stiffness
- Problems with urinating
- Flank pain and painful urination caused by stones
But not all patients experience symptoms. Also, the symptoms may variate from mild to severe. This is what you need to keep in mind – always get your blood and urine checked regularly, particularly if you are at higher risk of developing hyperuricemia as mentioned above.
What Are The Consequences of Having Abnormal Uric Acid Levels?
If too much uric acid is produced or too little is removed, then the accumulated uric acid in our body causes hyperuricemia and this can commonly cause a condition called gout (inflammation of the joint tissues from uric acid deposits). If the excess uric acid also deposit in the kidneys, then you may also suffer from kidney stones or kidney failure.
As seen above, uric acid is strongly related to gout, a common type of arthritis. Estimates show that 8 million people in the US or 4% of the population have gout. And this could be even higher as many people with gout do not experience any symptoms or are so mild that they do not seek medical help. Gout is characterized by sudden and severe pain, tenderness, swelling, and redness in the joints. The most frequently affected joint is at the base of big toe.
Apart from male and ethnicity, other risk factors that predispose you to gout are obesity, a diet rich in meats and seafood, alcoholic beverages (particularly beer), hypertension, diabetes, usage of certain diurectics, and chronic kidney disease.
Not everyone with hyperuricemia will experience gout. In fact many people with hyperuricemia do not develop any symptoms, and if there are no family history of renal disease or kidney stones, then a dietary and lifestyle management without any medical treatment suffice.
For those unfortunate enough to suffer from gout, then a combination of treatment is usually recommended:
- Treat symptoms with pain killer and anti-inflammation (usually a non-steroidal anti-inflammatory), colchicine, or glucocorticoids
- Dietary and lifestyle measures as described below to limit uric acid load in your body (this is both a preventative and also a therapeutic measure)
- Prevention with certain medications such as allopurinol.
What Can Be Done Regarding Abnormal Uric Acid Levels?
There are a lot of things that you can do on your own to help decrease your uric acid levels, or limit its continuing accumulation. The main thing to do is focus on improving your diet.
Avoid any foods which are known to contain high level of purines, such as yeast and yeast extracts (including beer), liver and meat extracts, spinach, beans, lentils, oatmeal, asparagus, mushrooms, and all types of alcohol. Instead, focus on the other available fruits and vegetables, peanut butter, egg, milk and milk products. Avoid drinking caffeine and alcohol and maintain hydrated. Start exercising on a daily basis – it does not need to be any massive exercising plan – a simple 30 minutes of walking or jogging should do just fine.
A diet with caloric restriction, limited refined carbohydrates and saturated fats but allowed increased proportion of protein, can lead to substantial weight loss and a significant reduction in serum uric acid.
Your doctor will also treat you with a combination of medications as mentioned above.
When Should You Visit Your Doctor?
Hyperuricemia without symptoms is not a cause for concern and if you do not have any symptoms or family history of kidney stones or renal failure, then following lifestyle and dietary recommendations above will suffice. But if any of the above symptoms appear, or a family history of kidney stones or kidney failure is present, then manage your hyperuricemia medically as well.
Part of the management whether with or without your doctor, is tracking your uric acid levels regularly both in the blood and the urine. This way you know if the efforts put in are seeing results.
What Further Testings Should Be Done?
The basic test is as always a blood test to measure the levels of uric acid in the blood. A urine test is also performed since uric acid is removed from the body through the urine. A 24-hour urine sample and a blood test are usually enough to determine whether or not the patient is dealing with hyperuricemia. If you are suffering from gout, the doctor can also take a sample of the fluid around the inflamed joint to determine the levels of uric acid.
A renal function test to look at the status of kidney function should be monitored closely, even if you don’t have kidney stones. This way any early damage to your kidneys can be detected early (as no symptoms are usually present), and the course of your treatment modified accordingly.
Hyperuricemia and gout can cause debilitating disease and serious consequences to your health. It is easily diagnosed, prevented and treated with lifestyle, dietary and medical measures combined.
Gout commonly affects the joint in the great toe, and its treatment must include symptomatic relief, prevention from future attacks (dietary, lifestyle and medical), and monitoring for development of kidney stones and failure.
Both hyperuricemia and gout can be easily detected with blood and urine tests. Given the number of people with these conditions and without symptoms (or very mild symptoms), screening is a very useful tool to track for these disease and prevent unhealthy consequences!
If you want to find out more about uric acid and managing high levels of it, take a look at our lifestyle article here!
Interested in other biomarkers? Check out the rest of The Biomarker Handbook.
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