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Uric Acid – Levels, Gout & Treatment Explained

Uric acid is a natural metabolic byproduct formed during the breakdown of purines. Elevated levels in the blood can lead to gout and kidney stones.

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Uric acid is a natural metabolic byproduct formed during the breakdown of purines. Elevated levels in the blood can lead to gout and kidney stones.

What is Uric Acid?

Uric acid is a natural waste product produced when the body breaks down purines -- chemical compounds found in the body cells and in many foods. Under normal circumstances, uric acid dissolves in the blood, passes through the kidneys, and is excreted in the urine. Problems arise when the body produces too much uric acid or the kidneys excrete too little of it.

Formation and Metabolism

Purines are found naturally in the body and in many foods. When cells die or food is digested, purines are broken down and converted into uric acid in the liver. Uric acid is then transported through the bloodstream to the kidneys, where it is filtered and eliminated through urine.

Approximately two-thirds of uric acid is excreted via the kidneys.
One-third is broken down in the intestines.
Normal blood levels are 3.4–7.0 mg/dL in men and 2.4–5.7 mg/dL in women.

Causes of Elevated Uric Acid (Hyperuricemia)

Persistently high uric acid levels in the blood are referred to as hyperuricemia. Common causes include:

Diet: excessive consumption of purine-rich foods such as red meat, organ meats, shellfish, and alcohol (especially beer)
Obesity and being overweight
Genetic predisposition: family history of elevated uric acid production
Kidney disease: reduced ability to excrete uric acid
Certain medications: such as diuretics or low-dose aspirin
Medical conditions: including leukemia, psoriasis, or hypothyroidism

Symptoms and Associated Conditions

High uric acid levels often cause no symptoms for a long time. However, when uric acid crystals accumulate in joints or tissues, the following conditions may develop:

Gout (gouty arthritis): sudden and very painful joint inflammation, most often affecting the big toe
Tophi: deposits of uric acid crystals beneath the skin
Kidney stones: uric acid stones in the urinary tract
Chronic kidney disease: long-term kidney damage caused by persistently high uric acid levels

Diagnosis

Hyperuricemia is diagnosed through a simple blood test measuring uric acid levels in the serum. If gout is suspected, the following additional tests may be performed:

Joint fluid aspiration to detect uric acid crystals under a microscope
Ultrasound of affected joints
Urine analysis to assess the amount of uric acid being excreted

Treatment and Management

Dietary Changes

A low-purine diet can significantly reduce uric acid levels. Recommendations include:

Reducing intake of red meat, organ meats, and shellfish
Limiting alcohol, especially beer
Drinking plenty of fluids (at least 2 liters of water per day)
Increasing intake of plant-based foods, dairy products, and coffee (in moderation)

Medication

For persistently elevated levels or recurrent gout attacks, the following medications may be prescribed:

Allopurinol: reduces uric acid production by inhibiting xanthine oxidase
Febuxostat: an alternative xanthine oxidase inhibitor
Uricosurics (e.g., benzbromarone): increase uric acid excretion through the kidneys
Colchicine, NSAIDs, or corticosteroids: used to treat acute gout flares

Prevention

Hyperuricemia can be prevented or managed through a healthy lifestyle, including a balanced diet, maintaining a healthy body weight, regular physical activity, adequate fluid intake, and moderate alcohol consumption.

References

Richette P, Doherty M et al. - 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29–42.
Neogi T - Gout. N Engl J Med. 2011;364(5):443–452.
World Health Organization (WHO) - Chronic diseases and health promotion: Gout and hyperuricaemia. Available at: www.who.int

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