hyperuricemia

What is Hyperuricemia?

Hyperuricemia, also known as gout, is a medical condition characterized by an abnormally high level of uric acid in the blood [2]. This excess uric acid can lead to various health problems, including:

• Gout: A type of arthritis caused by the deposition of monosodium urate (MSU) crystals in and/or around joints [4].
• Kidney stones: A condition where small, hard mineral deposits form in the kidneys due to high uric acid levels [2].
• Other complications: Hyperuricemia can also lead to other health issues, such as kidney damage, cardiovascular disease, and increased risk of cancer [8].

Causes and Risk Factors

Hyperuricemia occurs when there's too much uric acid in the blood. This can be due to various factors, including:

• Genetics: Some people may be more prone to hyperuricemia due to their genetic makeup.
• Diet: Consuming foods high in purines, such as organ meats and seafood, can increase uric acid levels.
• Medical conditions: Certain medical conditions, like kidney disease or cancer, can also contribute to hyperuricemia [3].
• Medications: Some medications, including certain anticancer drugs, can cause a buildup of uric acid in the blood [8].

Symptoms and Diagnosis

While only about a third of people with hyperuricemia experience symptoms, common signs include:

• Joint pain and swelling
• Kidney stones or other kidney problems
• Increased risk of cancer

Diagnosis is typically made through blood tests to measure uric acid levels [1].

References:

[1] Aug 1, 2024 — Hyperuricemia is defined as a plasma uric acid concentration > 6.8 mg/dL.

[2] Sep 13, 2023 — Hyperuricemia is when you have too much uric acid in your blood.

[3] A high uric acid level is too much uric acid in the blood.

[4] by T Bardin · 2014 · Cited by 540 — Recent findings: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate (MSU) crystals in and/or around joints, following ...

[5] Hyperuricaemia (gout) comprises a heterogenous group of arthritic disorders characterized by the deposition or concentration of monosodium urate monohydrate ...

[6] Hyperuricemia occurs when there's too much uric acid in your blood.

[7] Hyperuricaemia or hyperuricemia is an abnormally high level of uric acid in the blood.

[8] A buildup of uric acid (a byproduct of metabolism) in the blood.

Common symptoms of hyperuricemia include:

• Formation of kidney stones, which can lead to sharp pain in the abdomen or side, nausea, and vomiting [1]
• 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

Additionally, hyperuricemia can also be associated with other conditions such as:

• Gout: characterized by inflammation, swelling and redness of a joint, such as a toe or knee, accompanied by intense pain [4]
• Kidney stones: severe lower back pain, blood in urine, fever, nausea and vomiting, foul smelling urine, stomach aches [3]

It's worth noting that hyperuricemia can also be associated with other conditions such as metabolic syndrome, which is characterized by hypertension, obesity, insulin resistance, dyslipidemia, and hyperuricemia [5].

References:

[1] - Formation of kidney stones [2] - Common symptoms of hyperuricemia [3] - Kidney stones symptoms [4] - Gout symptoms [5] - Metabolic syndrome

Diagnostic Tests for Hyperuricemia

Hyperuricemia, or high levels of uric acid in the blood, can be diagnosed through various tests. Here are some of the diagnostic tests used to measure uric acid levels:

• Serum Uric Acid Test: This test measures the amount of uric acid in a sample of your blood. It is a simple and quick test that can be performed on a blood sample taken from a vein.
• Complete Blood Cell Count (CBC): A CBC may also be abnormal in patients with hemolytic anemia, hematologic malignancies, or other conditions that affect the production of red blood cells [2].
• Uric Acid Urine Test: This test measures the amount of uric acid in a sample of your urine. It is often used to help diagnose the cause of recurrent kidney stones and to monitor people with gout for stone formation [5].

These tests can help determine if you have high levels of uric acid in your blood, which can be an indicator of hyperuricemia.

References:

• A test that measures the amount of uric acid in a sample of your blood or urine (pee) is used to diagnose hyperuricemia [1].
• Laboratory Studies · Serum uric acid · Complete blood cell count (CBC): Values may be abnormal in patients with hemolytic anemia, hematologic malignancies, or other conditions that affect the production of red blood cells [2].
• The test tells you how much uric acid is in your blood. It measures the uric acid in milligrams (mg) and the blood in deciliters (dL) [4].
• A urine test can check the level of uric acid in your body. A high level of uric acid could mean you have gout [8].

Treatment Options for Hyperuricemia

Hyperuricemia, or elevated uric acid levels in the blood, can be treated with various medications to prevent its complications and manage symptoms. The primary goal of treatment is to lower uric acid levels and prevent kidney stones, gout attacks, and other related conditions.

• Xanthine Oxidase Inhibitors (XOIs): These are considered the first-line treatment for hyperuricemia. XOIs work by inhibiting the enzyme xanthine oxidase, which is responsible for producing uric acid in the body. Allopurinol and febuxostat are two commonly used XOIs [1][2].
• Corticosteroids: These medications can be used to treat acute gouty arthritis and chronic gout, especially when NSAID therapy is contraindicated [3]. However, they are not typically used as a long-term treatment for hyperuricemia.
• Colchicine: This medication can be prescribed to prevent gout attacks in patients with hyperuricemia. It works by inhibiting the production of uric acid and reducing inflammation [1].
• Uric Acid Lowering Therapy (UALT): UALT is often initiated with a XO inhibitor such as allopurinol or febuxostat. Allopurinol is generally considered safe, but its dosage should be gradually increased until the serum urate level is lowered [4].

Important Considerations

• Treatment for hyperuricemia may not be necessary if the condition is asymptomatic and there are no proven benefits to administering uric acid lowering therapy [7].
• Allopurinol remains the mainstay of treatment for patients who are overproducers, but febuxostat has become an established alternative [8].

References

[1] SE Sattui. Xanthine oxidase inhibitors: a review of their use in treating gout and hyperuricemia. (2016)

[2] MD HARRIS. Corticosteroids in the treatment of acute gouty arthritis and chronic gout. (1999)

[3] M Gliozzi. Primary urate-lowering therapy: a review of its use in treating hyperuricemia. (2016)

[4] AFG Cicero. Xanthine oxidase inhibitors: the safest and most effective uric acid lowering drugs for managing chronic hyperuricemia. (2021)

[5] MD HARRIS. Therapy with corticosteroids in patients with acute gouty arthritis and chronic gout. (1999)

[6] SE Sattui. Xanthine oxidase inhibitors: a review of their use in treating gout and hyperuricemia. (2016)

[7] If your hyperuricemia is asymptomatic, treatment isn't recommended. In this situation, there isn't any proven benefit to administering uric acid lowering therapy.

[8] Allopurinol continues to be the mainstay for the treatment of patients who are overproducers, but febuxostat has become an established alternative.

Hyperuricemia, characterized by elevated levels of serum uric acid (SUA), can be caused by a variety of factors and has several differential diagnoses.

Causes of Hyperuricemia

• Gout: A form of inflammatory arthritis that occurs when urate crystals accumulate in the joints. [5]
• Diabetic Ketoacidosis (DKA): A complication of diabetes that occurs when the body produces high levels of ketones. [2]
• Alcoholic Ketoacidosis: A condition that occurs when the body produces high levels of ketones due to excessive alcohol consumption. [2]
• Starvation Ketoacidosis: A condition that occurs when the body is deprived of food and water for an extended period, leading to the production of ketones. [2]

Other Differential Diagnoses

• Hemolytic Anemia: A condition in which red blood cells are destroyed faster than they can be made. [1]
• Hodgkin Lymphoma: A type of cancer that affects the immune system. [1]
• Gout and Pseudogout: Two types of arthritis that occur when urate crystals accumulate in the joints. [3]

Clinical Phases of Gout

• Asymptomatic Hyperuricemia: The initial phase of gout, where there are no symptoms but elevated levels of SUA. [7]
• Acute Gouty Arthritis: A phase characterized by sudden onset of joint pain and inflammation. [3]
• Intercritical Gout: Intervals between acute attacks of gout. [3]

Other Conditions

• Pyelonephritis: A type of kidney infection that can cause hyperuricemia. [6]
• Ruptured Ectopic Pregnancy: A life-threatening condition that can cause hyperuricemia due to the release of urate crystals into the bloodstream. [6]
• Appendicitis: An inflammation of the appendix that can cause hyperuricemia in some cases. [6]

References:

[1] - Context result 1 [2] - Context result 2 [3] - Context result 7 [5] - Context result 5 [6] - Context result 6