Where does uric acid come from?
Uric acid is the end product of purine metabolism. About two-thirds of it is formed in the body itself during cell renewal, and only the remaining part comes with food. It is excreted primarily by the kidneys, so any decrease in their function increases the level in the blood. When the solubility threshold is exceeded, uric acid salts precipitate in the form of crystals: they cause acute inflammation in the joints, form stones in the kidneys, and eventually form nodules in the tissues. The speed of this process depends not only on the number, but also on its persistence over time.
- Most of it is formed inside the body
- Excreted primarily by the kidneys
- Crystals are deposited when the solubility threshold is exceeded
- Asymptomatic hyperuricemia is the most common variant
- Gout is a clinical manifestation of joint deposits
- Urate kidney stones
Reasons for the increase
The leading mechanism in most people is reduced renal excretion. It is aggravated by chronic kidney disease, taking diuretics and some other drugs, dehydration and alcohol abuse, especially beer. The second mechanism is increased formation: with obesity, metabolic syndrome, abuse of fructose and sugary drinks, as well as with the breakdown of a large number of cells, for example during the treatment of tumors. Diet also has an effect, but its contribution is more modest than is commonly believed: severe food restriction reduces the level only slightly.
- Decreased kidney function
- Taking diuretics and certain medications
- Overweight and metabolic syndrome
- Alcohol, especially beer
- Sweet drinks with fructose
- Red meat, offal, seafood in large quantities
- Dehydration
- Cell destruction in the treatment of cancer
How can it manifest itself?
In most cases, elevated uric acid is not felt at all and is detected during routine analysis. The first clinical manifestation is usually an attack of gout: at night or in the morning, very severe pain suddenly occurs in the joint, most often the big toe, the joint turns red, swells, and the touch becomes unbearable. The second option is renal colic when a urate stone passes. Over a long period of time, dense, painless nodules may appear under the skin. It is important to remember that during an acute attack, uric acid levels may be normal.
- Asymptomatic
- Acute attack of joint pain
- Redness and swelling of the joint
- Renal colic
- Blood in urine due to stones
- Dense nodules under the skin with a long course
Survey
The level of uric acid is determined, but one analysis is not enough: when an increase is detected for the first time, it is repeated, since the value fluctuates. Be sure to evaluate kidney function using creatinine and urine analysis, and also look for concomitant conditions that often go together: overweight, high blood pressure, disorders of carbohydrate and fat metabolism. Kidney ultrasound reveals stones. In case of joint pain, the diagnosis of gout is confirmed by a rheumatologist, ideally by the detection of crystals in the joint fluid, since infectious arthritis and other diseases give a similar picture.
- Blood uric acid is repeated
- Creatinine and kidney function calculation
- General urine test
- Kidney ultrasound
- Glucose, lipid profile, pressure measurement
- Examination by a rheumatologist for joint complaints
- Review of medications taken
Treatment and lifestyle
For asymptomatic elevations, medications are usually not prescribed: the focus is on weight loss, limiting alcohol and sugary drinks, drinking enough, and reviewing medications that increase levels. Drug reduction is indicated for gout, urate stones and in certain situations, as decided by the doctor; Such drugs are taken for a long time and under the control of tests. It is impossible to start them during an acute attack without covering them with anti-inflammatory therapy. Diet helps, but its effect is limited, so you don’t need to fast and completely eliminate protein: sudden fasting, on the contrary, increases uric acid levels.
- Gradual weight loss without fasting
- Limiting alcohol, especially beer
- Avoiding sugary carbonated drinks
- Adequate drinking in the absence of contraindications
- Moderate consumption of red meat and organ meats
- Low-fat dairy products and vegetables in the diet
- Reviewing diuretics with your doctor
- Drugs that reduce uric acid, according to indications
