uric acid, hyperuricemia

What is hyperuricemia?
Hyperuricemia is an excess of uric acid in the blood. Uric acid passes through the liver, and enters your bloodstream. Most of it is excreted (removed from your body) in your urine, or passes through your intestines to regulate "normal" levels.
Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male).  Normal values will vary from laboratory to laboratory.

Also important to blood uric acid levels are purines.  Purines are nitrogen-containing compounds, which are made inside the cells of your body (endogenous), or come from outside of your body, from foods containing purine (exogenous).  Purine breaks down into uric acid. Increased levels of uric acid from excess purines may accumulate in your tissues, and form crystals. This may cause high uric acid levels in the blood.

Uric acid formation may occur when the blood uric acid level rises above 7 mg/dL. Problems, such as kidney stones, and gout (collection of uric acid crystals in the joints, especially in your toes and fingers), may occur.

What causes hyperuricemia?

Causes of high uric acid levels (hyperuricemia) can be primary (increased uric acid levels due to purine), and secondary (high uric acid levels due to another disease or condition). Sometimes, the body produces more uric acid than it is able to excrete.
Causes of high uric acid levels include:

• Primary hyperuricemia
  • Increased production of uric acid from purine
  • Your kidneys cannot get rid of the uric acid in your blood, resulting in high levels
• Secondary hyperuricemia
  • Certain cancers, or chemotherapy agents may cause an increased turnover rate of cell death. This is usually due to chemotherapy, but high uric acid levels can occur before chemotherapy is administered.
  • After chemotherapy, there is often a rapid amount of cellular destruction, and tumor lysis syndrome may occur. You may be at risk for tumor lysis syndrome if you receive chemotherapy for certain types of leukemia, lymphoma, or multiple myeloma, if there is a large amount of disease present.
  • Kidney disease - this may cause you to not be able to clear the uric acid out of your system, thus causing hyperuricemia.
  • Medications - can cause increased levels of uric acid in the blood
  • Endocrine or metabolic conditions -certain forms of diabetes, or acidosis can cause hyperuricemia
  • Elevated uric acid levels may produce kidney problems, or none at all. People may live many years with elevated uric acid levels, and they do not develop gout or gouty arthritis (arthritis means "joint inflammation"). Only about 20% of people with elevated uric acid levels ever develop gout, and some people with gout do not have significantly elevated uric acid levels in their blood.

What are some symptoms of hyperuricemia to look for?

• You may not have any symptoms.
• If your blood uric acid levels are significantly elevated, and you are undergoing chemotherapy for leukemia or lymphoma, you may have symptoms kidney problems, or gouty arthritis from high uric acid levels in your blood.
• You may have fever, chills, fatigue if you have certain forms of cancer, and your uric acid levels are elevated (caused by tumor lysis syndrome)
• You may notice an inflammation of a joint (called "gout"), if the uric acid crystals deposit in one of your joints. (*Note- gout may occur with normal uric acid levels, too).
• You may have kidney problems (caused by formation of kidney stones), or problems with urination

Things you can do about hyperuricemia:

• Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).  
• Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.
• Follow your healthcare provider's instructions regarding lowering your blood uric acid level and treating your hyperuricemia. If your blood levels are severely elevated, he or she may prescribe medications to lower the uric acid levels to a safe range.

If you have an elevated blood uric acid level, and your healthcare provider thinks that you may be at risk for gout, kidney stones, try to eat a low purine diet.

Foods that are high in purine include:

• All organ meats (such as liver), meat extracts and gravy
• Yeasts, and yeast extracts (such as beer, and alcoholic beverages)
• Asparagus, spinach, beans, peas, lentils, oatmeal, cauliflower and mushrooms

Foods that are low in purine include:

• Refined cereals - breads, pasta, flour, tapioca, cakes
• Milk and milk products, eggs
• Lettuce, tomatoes, green vegetables
• Cream soups without meat stock
• Water, fruit juice, carbonated drinks
• Peanut butter, fruits and nuts
• Keep well hydrated, drinking 2 to 3 liters of water per day, unless you were told otherwise.
• Take all of your medications for hyperuricemia as directed
• Avoid caffeine and alcohol, as these can contribute to problems with uric acid and hyperuricemia.
• Avoid medications, such as thiazide diuretics (hydrochlortiazide), and loop diuretics (such as furosemide or Lasix^®). Also, drugs such as niacin, and low doses of aspirin (less than 3 grams per day) can aggravate uric acid levels. Do not take these medications, or aspirin unless a healthcare provider who knows your condition told you.
• If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Drugs or treatments that may be prescribed by your doctor to treat hyperuricemia:

Your doctor or healthcare provider may prescribe medications if you have a high blood uric acid levels. These may include:

• Non-steroidal anti-inflammatory (NSAID) agents and Tylenol^®- such as naproxen sodium and ibuprofen may provide relief of gout-related pain. Gout may be a result of a high uric acid level.
• If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol() up to 4000 mg per day (two extra-strength tablets every 6 hours) may help.
• It is important not to exceed the recommended daily dose of Tylenol, as it may cause liver damage. Discuss this with your healthcare provider.
• Uricosuric Drugs: These drugs work by blocking the reabsorption of urate, which can prevent uric acid crystals from being deposited into your tissues. Examples of uricosuric drugs include probenecid, and sulfinpyrazone.
• Xanthine oxidase inhibitors - Such as allopurinol, will prevent gout. However, it may cause your symptoms of gout to be worse if it is taken during an episode of painful joint inflammation.
• Allopurinol may also be given to you, if you have a certain form of leukemia or lymphoma, to prevent complications from chemotherapy and tumor lysis syndrome - and not necessarily to prevent gout. With high levels of uric acid in your blood, as a result of your disease, the uric acid will collect and form crystals in your kidneys. This may occur during chemotherapy, and may cause your kidneys to fail.

When to call your doctor or health care provider:

• Localized joint pain (especially in a toe or finger joint), that is red and inflamed.
• Shortness of breath, chest pain or discomfort; should be evaluated immediately.
• Feeling your heart beat rapidly (palpitations).
• Bleeding that does not stop after a few minutes.
• Any new rashes on your skin - especially if you have started any new medications.