What is hyperuricemia?

Written by Chen Xie
Endocrinology
Updated on August 31, 2024
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Hyperuricemia refers to a condition where, under normal purine diet, fasting blood uric acid levels exceed 420 micromoles per liter in males and 360 micromoles per liter in females. Uric acid is the final metabolic product of human purine compounds. Disorders in purine metabolism lead to hyperuricemia, which is influenced by various factors including genetics, gender, age, lifestyle, dietary habits, medical treatments, and the level of economic development. Clinically, hyperuricemia can be classified into primary and secondary types. Common clinical manifestations mainly include gout, and possibly arthritis, which are closely related to hypertension, diabetes, hyperlipidemia, coronary heart disease, and renal impairment. Therefore, it is necessary to control hyperuricemia.

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Pre-symptomatic hyperuricemia

Hyperuricemia in the preclinical phase can be asymptomatic, only showing fluctuating or persistent hyperuricemia during blood tests. From the increase in uric acid to the onset of symptoms, it can generally take several years to decades. Additionally, some changes in the kidneys due to the deposition of uric acid can cause manifestations of gouty nephropathy. Early stages may present intermittent proteinuria and increased urine foam. As the condition progresses, the kidney's concentrating ability may decrease, resulting in increased nighttime urination. Further progression can lead to renal insufficiency, elevated creatinine and urea nitrogen, and possibly swelling and hypertension. In severe cases, acute renal failure may occur, showing symptoms of oliguria or anuria. This type of uric acid nephropathy is primarily due to the deposition in the kidneys, causing episodes of kidney stones and back pain, with stone episodes also accompanied by hematuria. Therefore, the main presentations are associated with the deposition of uric acid in the kidneys during the preclinical phase of hyperuricemia.

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What is contraindicated for hyperuricemia?

Hyperuricemia contraindications include the following points: 1. Strictly limit the intake of purines, restrict foods that contain more purines, including animal organs, bone marrow, seafood, fermented foods, beans, etc. 2. Reduce the intake of fats, as fats can decrease the excretion of uric acid. 3. Avoid high-protein foods, such as lean meat, chicken, and duck, which should be boiled and the broth discarded before consumption to avoid eating stewed or marinated meats. 4. Abstain from alcohol, as alcohol can lead to the accumulation of lactate in the body and inhibit the excretion of uric acid, easily triggering gout attacks. 5. Avoid hot pot, as the main ingredients in hot pot are animal organs, shrimp, shellfish, and seafood, and drinking beer with it can aggravate the condition, making these items contraindications for hyperuricemia.

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Written by Chen Xie
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How is hyperuricemia treated?

The treatment of hyperuricemia mainly includes the following points: 1. Improve lifestyle primarily, including a low-purine diet, appropriate exercise, smoking cessation, and increased water intake. 2. Alkalize urine using sodium bicarbonate to maintain urine pH value between 6.2 and 6.9, which facilitates the excretion of uric acid. 3. Avoid drugs that increase uric acid levels, such as diuretics, corticosteroids, and insulin. 4. Use medications that lower uric acid levels; drugs that increase uric acid excretion mainly include probenecid and sulfinpyrazone, and drugs that inhibit uric acid synthesis mainly include febuxostat and allopurinol. However, the treatment with these drugs has specific indications, contraindications, and related side effects. It is advised to use medication under the guidance of a doctor and avoid choosing drugs for treatment arbitrarily.

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Dietary Guidance for Hyperuricemia

For hyperuricemia, it is generally recommended to adopt a low-calorie diet, control weight, and try to maintain an ideal weight. Secondly, avoid high-purine foods and opt for a diet low in purines. The third point encourages the use of some alkaline medications and strict abstinence from alcohol. The fourth point is to reduce the intake of fructose-rich beverages. The fifth point is to avoid drinking strong tea, coffee, cocoa, and other such beverages. The sixth point emphasizes the need to drink more water, recommending a daily water intake of at least 2000 milliliters.

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Hyperuricemia and Its Complications

Hyperuricemia mainly refers to the elevation of uric acid levels in the blood, with levels exceeding 420 umol/l in males and 360 umol/l in females being diagnostic criteria. Some patients with hyperuricemia may not show symptoms, but if not controlled, complications can arise such as gouty arthritis, which manifests as local joint redness, swelling, heat, and pain, and even limited mobility. If it affects the kidneys, it leads to gouty kidney, which is characterized by abnormal kidney function and elevated creatinine levels. Therefore, if diagnosed with hyperuricemia, it is advisable to control diet, drink plenty of water, and seek timely medical treatment.