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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Written by Chen Xie
Endocrinology
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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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Hyperuricemia manifestations

Most cases of hyperuricemia usually have no obvious clinical symptoms, and it can take years to decades from the increase in blood uric acid to symptom onset, with some individuals never exhibiting obvious clinical symptoms throughout their lifetime. However, as age increases, the incidence of gout becomes higher. When accompanied by acute gouty arthritis, patients may experience severe joint pain. If blood uric acid levels remain high over a long period, this can lead to the formation of gouty tophi and uric acid stones, among other issues.

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Is hyperuricemia contagious?

Hyperuricemia is not contagious. Hyperuricemia refers to a condition where the concentration of uric acid in the blood exceeds the normal upper limit. Typically, for males and post-menopausal females, a blood uric acid concentration greater than 420 µmol/L, or pre-menopausal females with more than 348 µmol/L, is considered hyperuricemia. Most severe cases of hyperuricemia are due to deficiencies in uric acid metabolism enzymes and fall under the category of liver metabolism disorders. Moreover, mild to moderate hyperuricemia is often associated with obesity, type 2 diabetes, hyperlipidemia, hypertension, arteriosclerosis, and coronary heart disease, among others. It is a type of nucleic acid metabolic disease, and therefore, it is not contagious.

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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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Treatment of Hyperuricemia with Medication

The treatment of hyperuricemia primarily involves dietary control, focusing on low-purine foods, increasing water intake, and maintaining regular exercise. Additionally, alkalizing the urine using sodium bicarbonate to keep the urine pH between 6.2 and 6.9 can help facilitate the excretion of uric acid. It's also important to avoid medications that can increase uric acid levels. For reducing uric acid, treatments mainly include probenecid, which can increase the excretion of uric acid, and febuxostat, an alternative to allopurinol, though side effects of these medications should be noted. Therefore, it is advised for patients with hyperuricemia to consult a doctor at a reputable hospital before taking any medications.