Uricemia, when is it necessary to take the exam?

Often high levels of uric acid in the blood do not cause symptoms, but in some people they can for example get gout or have kidney problems.

What do Charlemagne, Piero de’ Medici (Lorenzo’s father), the Sun King, Pope Julius II have in common? Apart from going down in history, they have all suffered from gout, a metabolic disease that causes painful bouts of inflammatory arthritis, with redness and swelling of the joints.

Once it was considered “stuff for the rich” because its main trigger is a diet rich in meats, cold cuts, cheeses, sweets – foods that in past centuries few could afford in large quantities – together with genetic predisposition (which was also favored by the fact that the nobles married each other, sometimes even between relatives, with an inevitable transmission of the predisposition itself).

The cause of gout is actually the accumulation of uric acid in the blood: when it is in excess, it causes the formation of crystals that are deposited in the joints causing inflammation. Today that we can all afford to exaggerate with foods of animal origin – indeed, nothing costs less than “fast-junk food” made of hamburgers, snacks and packaged foods – together with the spread of chronic renal failure (often silent), overweight, obesity and aging of the population, the diseases linked (or worsened) by excess uric acid are numerous.

And that’s why often the doctor, in prescribing a general check-up or to define a diagnostic picture if we have a disorder, often inserts uricemia, or the measurement of uric acid levels in the blood, useful in case certain types of pain or specific symptoms of other kinds occur.

“Hyperuricemia, i.e. a high concentration of uric acid, occurs when the value is above 7 mg per deciliter for men, and 6.5 mg per deciliter for women of childbearing age,” explains Andrea D’Alessio, head of the Internal Medicine and Oncology Unit of the Policlinico San Marco di Zingonia (BG) – San Donato Group.

Uric acid is a final product of metabolism, that is, destruction, purines, molecules that are produced by the body but can also be introduced with food. Uric acid, after being thus produced by the normal metabolism of purines, is eliminated from the body through the kidneys.

“The difference between males and females begins in puberty: in pediatric age the values of uric acid are very low, women are then more protected from estrogen until menopause, when the risks become equivalent to those of men”.

The rise in uric acid occurs mostly silently: “It is symptomatic in patients who then fall ill with gout or have a precipitation of uric acid in the kidney that causes the formation of stones, for example. But high uric acid values, i.e. above 7 or 8 mg / dl, are quite frequent and asymptomatic in the population: it is true for about 7-8 percent of Italians».

It follows the usefulness of diagnosing this type of problem as soon as possible, so as to prevent them from degenerating into worse diseases such as, in fact, kidney stones or other urinary tract disorders, and to constantly measure the risk associated on the basis of reference values.

The causes of hyperuricemia

Why does uric acid rise? “It happens when the production of purines increases: due to genetic predisposition, due for example to enzymatic alterations that induce the body to a greater production of purine and consequently of uric acid, or to kidneys less efficient in eliminating the latter. Most often they increase due to physiological conditions: the most frequent is dehydration, because the reduction of plasma volume leads to an increase in uric acid when the blood concentrates. Obesity also leads to the overproduction of uric acid and the same happens in oncological diseases, both in the early stages of the tumor and in the treatment phase with chemotherapy or radiotherapy.

As in the past, lifestyle also counts: “First of all, a diet characterized by excessive consumption of alcohol and foods rich in purines, such as red and white meats, offal, herring, anchovies, sardines, mussels, game, cold cuts, legumes, asparagus, spinach, cauliflower, mushrooms, etc. Fruitarian subjects, or those who consume large quantities of fruit in general, should know that fructose promotes hyperuricemia, as it reduces renal elimination. Some medications may also play a role: for example, thiazide diuretics or salicylates, and some hypertension medications, such as ACE inhibitors and some sartans. Finally, living in polluted cities also contributes to hyperuricemia.”

If food excesses have historically been associated with hyperuricemia, paradoxically hunger can also be the cause: “If the diet is too low in carbohydrates, the body uses its own proteins, taken from the muscles, and residual fats: this determines lactic acidosis which, often, is aggravated by a high-protein diet. If this diet lasts beyond ten to fifteen days, the destruction of muscle cells causes an increase in uric acid and its precipitation in the kidneys, with health risks.

The consequences of hyperuricemia

Andrea D’Alessio continues: “In general, monosodium urate crystals derived from uric acid can precipitate in the joints and determine gout or end up in the renal tubules causing stones or urate nephropathy. It happens, for example, in some blood cancers that, by raising uric acid, also induce renal failure that can even lead to dialysis. But if there are diseases with serious consequences, even a high value of uric acid that does not give symptoms should not be underestimated: “Which, moreover, is the most common condition: it affects two thirds of people with hyperuricemia. But the risk of pathologies is high: in the long run it can give cardiovascular complications, hypertension, worsening of coronary heart disease or metabolic disease (hypertension-hyperlipidemia-gas liver), up to induce insulin resistance and development of diabetes mellitus“.

Gout is often considered a disease of the past, but the Italians who are estimated to be affected are about 1% and 8% among the over 65s. More often than in the past, women are affected: sometimes for the abuse of diuretics used in a senseless way as slimming.

Diagnosis of hyperuricemia

Discovering hyperuricemia is easy even in the absence of symptoms: “A trivial blood sample is enough, with a prescription from the family doctor or internist. It is done routinely in people with metabolic problems, heart disease, hypertensive, with nephropathy, obese or with an unregulated life, but sometimes also as a screening in healthy people, as well as periodically checking blood count, blood sugar or creatinine. It is also dosed if there are other diseases, for example in cancer patients, to prevent hyperuricemia from interfering with the effectiveness of therapies ». Therefore, keeping some essential parameters constantly under control, even through a simple blood test, is essential to identify this problem.

As for treatment, hyperuricemia requires a holistic approach. Andrea D’Alessio explains: “If there is a symptomatic disease, the therapy aims to reduce uric acid relatively quickly with drugs that block its synthesis or promote its elimination at the renal level. Or, vice versa, the main pathology is treated with ad hoc drugs, and uricemia is intervened with diet, for example. In asymptomatic subjects or in whom the symptoms have not yet manifested acutely (for example the patient who already has deposits in the joints, but does not suffer from gout attacks) a softer, non-pharmacological approach is possible, aimed only at lifestyle changes: lose weight, practice physical activity, drink plenty of water, Rebalance the diet by eliminating excesses, reducing alcohol and sugary drinks. The drugs taken are evaluated, possibly replacing them with others that do not favor hyperuricemia. Those who practice sports, often underestimate the importance of hydration before, during and after and drinking as much water (preferably low-sodium) as required by the season and the intensity of the practice carried out: if plasma density increases, all catabolites increase, with worsening of renal function and blood viscosity that circulates more slowly. An empirical parameter of dehydration is the color of the urine: if it is very dark, we are not drinking enough. Once all these elements are considered, the goal of the changes will be to bring uric acid below 7 mg/dl, even better below 6 mg/dl.

If necessary, the doctor will evaluate further in-depth examinations: “With the anamnesis we try to understand if it is a family problem, what are any other pathologies present, such as the drugs taken, lifestyle, alcohol intake, sugar and smoking habit (in particular for menopausal women, suddenly no longer protected by estrogen and with a worsening of the metabolic and cardiovascular picture) and therefore can be prescribed further investigations’. For example, the collection of urine in 24 hours to assess the amount of uric acid excreted.

These are therefore tests and services that, like the simple blood sampling, can be easily carried out at specialized centers but also in any clinical analysis laboratory, even at public hospitals, and which often manage to diagnose in time pathological conditions that could worsen if not treated accurately.

There is also the possibility – rarer and less worrying, in general – of hypouricemia, that is, values below the norm of uric acid: the most frequent causes are anemia, vegan diet and undernutrition, liver diseases (viral hepatitis), lactic acidosis (metabolic decompensation that causes accumulation of acids in body tissues and fluids), nephropathies, estrogen-based therapies, salicylates, cortisone.

How to prevent hyperuricemia

In summary, here are some tips to maintain balanced uric acid values:

  1. Do not eliminate starchy carbohydrates from the diet (pasta, bread, rice, potatoes, etc.) because they help eliminate it.
  2. Reduce sweets, sugary fruits (figs, persimmons, bananas, grapes and dried fruit), sugary drinks because fructose promotes the accumulation of uric acid.
  3. Beware of low-calorie diets or prolonged fasting. Fasting or prolonged absence of nutrients can worsen, in addition to uricemia, also the results of blood tests.
  4. Avoid hard liquor, beer and alcohol in general, as well as smoking, excess caffeine and other bad habits in the field of lifestyle nutrition.
  5. Drink 2 liters of water a day. Integrating in abundance the lost liquid with normal daily activities is very important to maintain the health and well-being of the body; In the short term, then, it can improve the results of the analysis of the single blood sample.
  6. Maintain a healthy weight or lose weight if it is in excess.
  7. Reduce animal fats and take five servings a day of vegetables, including vegetables and fruits. Exaggerating with animal products, as mentioned, is one of the main risk factors for the onset of hyperuricemia; Conversely, fruits and vegetables help maintain proper micronutrient levels, so you don’t have to resort to dietary supplements.

In addition to this, we remind you that it is always essential to contact specialists in case of doubts, perplexities, prevention advice, or simply to book a check-up, so as to verify the full functionality of your body and treat in time all the problems related to uricemia.

In addition, only professionals can prescribe the right drugs for the treatment of the disease or, if it is precisely medicines that worsen uricemia levels (this is the case of some therapies for arterial hypertension), suggest resorting to alternative treatments, which still have, for the patient, the effect of improving their condition.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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