High uric acid level? Here is what you should know.

If you are reading this, then there is high chance that you know someone who has high uric acid level and worried about this. But I am going to tell you that you need not worry much because here is what you need to know and do.

Before discussing about what we should do or what you should not do after being detected for high uric acid, it is good to know what causes high uric acid level in the first place.

Image Credit: healthline.com
Image shows the base of big toe with uric acid crystal deposition

How is uric acid produced?

To understand this, let’s go back to some basic biology and chemistry so that we can really appreciate the amazing biochemistry. We all know from basic biology that cell is the structural and functional unit of life. What this really means is that the overall structure of our body is made from combination of many unit of cells and the function of any organ-system in the body is the function of specific cell found in that organ. What we should know is that although cell makes up body, cell is not the smallest component that makes up body. What I mean by this is that inside cell there are various small cell organelles with their own function. One of the most important components inside the cell is nucleus. Out of many structures inside nucleus, one that is particularly important for our discussion here is chromosome. Human body contain 23 pairs of chromosomes. Inside the chromosome we have DNA. DNA contains number of genes that contains all the genetic information of the organism. Like DNA, there is another important structure inside the cell which is RNA. This is found outside the nucleus.

After we have understood that we have DNA and RNA from the above discussion related to biology, now we can talk about the production of uric acid. To understand this we have to know the chemistry of DNA and RNA.

Like our body is made up of many cells, DNA and RNA are also made up of many units of something. That something is what we call nucleotide. If both DNA and RNA are made up of nucleotide then how are they different? To understand this we have to go one step deeper into what actually makes up nucleotide.

Nucleotide is made up of three components:

1.     Phosphate: Common for both DNA and RNA

2.     Sugar: RNA contains ribose sugar and DNA contains deoxy ribose sugar. By deoxy we mean to say DNA sugar contains one hydroxy group (-OH group) less than RNA.

3.     Nitrogenous base: It can be further classified as

a.     Purines: Adenine, Guanine (Found in both DNA and RNA)

b.     Pyrimidines: Cytosine, Uracil, Thymine (Pyrimidine Uracil is found only in RNA and Thymine is found only in DNA)

DNA and RNA can also be differentiated based on the number of strands. DNA is usually double stranded, and RNA is usually single stranded. But we should not forget that DNA can be single stranded as well and RNA can be double stranded as well in some bugs.

Now we are done with almost all the biochemistry necessary for our discussion. The least that you should understand till this time is that we have DNA and RNA and one of the important components of DNA and RNA is purines (Adenine and Guanine). Uric acid is nothing but just a metabolic end product of purines. Just like carbohydrate is metabolized to glucose, protein is metabolized to amino acid, purines from DNA and RNA are metabolized to uric acid.

As our body grows, there are numerous new cells produced daily and at the same time many old cells are dying as well. When cell is multiplying then at that time the number of DNA should also multiply so that both the cell contains DNA. DNA replicates itself to produce more DNA for this purpose. If there is any defect during replication then our body tries  to repair that defect but if it fails to repair then to prevent defective multiplication of cell leading to cancer our body kills that defective cell by a process known as apoptosis. When the cell is dead, its component is metabolized. At this time DNA and RNA are also metabolized. Since DNA and RNA contains purines, uric acid is produced in the process. Not just defective cell but the normal healthy cell also dies after its certain lifetime and uric acid is produced in this process also. What this tells us is that there is a certain normal level of uric acid always present in our blood.  The normal range of uric acid is 3.0 – 8.2 mg/dl. However, the value varies according to gender and labs.

What causes increase in uric acid level?

Uric acid level can be increased by mainly two mechanism. There can be overproduction of uric acid or the under-excretion of uric acid. Under-excretion of uric acid is the major factor for increasing uric acid level.

1.     Under-excretion of uric acid

As we have seen uric acid is continuously being produced in the body, its level is maintained by excreting excess uric acid in the urine. To make us pee is the function of kidney. So uric acid can be increased in case of:

a.     Renal failure: 

    Kidney fails to excrete uric acid.

b.    Alcohol: 

    During the metabolism of alcohol, Lactic acid is produced. Now these two acids (Lactic acid and uric acid) competes for excretion. Lactic acid slows the excretion of uric acid and its level increase.

These are the classic cause of increase in uric acid. Beside this, anything that decreases filtration rate from kidney (glomerular filtration rate) is going to decrease uric acid excretion and increase uric acid level in blood.

a.     Use of diuretics

b.     Hypovolemia

2.     Overproduction of uric acid

About 10% cause of hyperuricemia is due to overproduction of uric acid. If we have understood that uric acid is the byproduct of purine then it is logical to understand that food rich in purines increases uric acid. Let’s see what such foods are:

a.     Foods that increase uric acid level

i.                   Red meat

ii.                 Sea food (especially Shellfish)

iii.               Alcohol

b.     Trauma/ Surgery

We have discussed above that when cell dies, its DNA and RNA are metabolized to produce uric acid. So during any trauma, surgery, chemotherapy large number of cells dies and as a result increase in uric acid (Hyperuricemia) is one of the complications.

Who are at risk for having increase uric acid?

a.     Male sex (Risk in female increases after menopause)

b.     Obese

c.      Weight gain

d.     Diabetes

e.     Hypertension

f.       Alcoholics

Complications of high uric acid level

Uric acid when present in excess amount, can crystallize in the body. Uric acid crystals deposition in various parts are the basis for its complications. The two major complications are :

1.     Gout

2.     Kidney Stone

Gout

Gout is a form of arthritis(joint pain) caused by build up of uric acid crystals in the joint. Small joint at the base of big toe (podagra) is the main site for deposition of uric acid crystals and gout attacks. Gout is characterized by swelling, redness and pain in the affected joint. Gout attack mainly occurs when there is:

Hyperuricemia (Increase uric acid) + Cool temperature (morning) + Genetic predisposition (if parent has gout, children are likely to have gout)

 

Image Credit: tristatearthritis.com
Image shows uric acid deposition at the base of big toe

Other than the base of big toe, uric acid can deposit in other joints as well like Knee, elbow, ankles, fingers.

Image Credit: webmd.com
Image shows gout affecting knee joint

Image Credit: thegoutkiller.com
Image shows gout affecting ankle

During attack the pain can be so severe that even the bed sheet touching the toe can elicit pain. The pain usually subsides within hours or days with or without medication. But if it is not treated then the gout attack can occur repeatedly occur over the years.

So, it is recommended that if you had gout attack once then have your uric acid level tested even if the pain is gone. Over the time, it can damage joints, tendons, and other tissues.

 

Kidney Stone

Uric acid crystals can deposit in kidney as well leading to the formation of stone. About 5% of kidney stone are because of uric acid. Long term deposition of uric acid in the kidney can lead to renal failure, Hypertension and Diabetes.

 

Chronic Tophaceous Gout

Tophi are the uric acid collections in connective tissue. When uric acid level is high for a very long time in the body, then it can deposit in tissues other than joints as well. These are called tophi. The most common sites of tophi formation are external ear, Achilles tendon. Tophi are usually not painful.

 

Image Credit: flickr.com
Image shows tophi in the external ear

Prevention from Gout

1.      Drink plenty of water

Maintaining adequate fluid attack can prevent crystallization of uric acid and kidney stone formation.

2.      Avoid alcohol

Image Credit: healthtipspedia.com

Alcohol and caffeine can cause dehydration and precipitate gout attack. In addition to this, alcohol produces lactic acid and slows down the excretion of uric acid. This way it increases uric acid and precipitate gout attack. So if you have a high uric acid then alcohol is something you do not want to drink during Saturday night party.

3.      Avoid purine rich foods

We have discussed couple times how purine is converted to uric acid. So if you have high uric acid level, it is strongly recommended to avoid purine rich foods. These include: Red meat, Sea foods, liver, brain, kidney.

4.      Take low fat dairy products

Dairy consumption seems to reduce the attack of gout.

5.      Reduce weight

Since obesity and weight is one of the major risk factors for gout, reducing weight can help from gouty attack. Even though you have no gout, obesity is the major risk factor for many non-communicable diseases, so its always better to have your weight reduced.

 

Treatment of Gout

There are several medications available to reduce inflammation and pain. Other medications are available to decrease the production of uric acid and increase the excretion of uric acid. You can get these medications prescribed from your doctor.

I hope this was useful. If you have any queries then please let me know.