Uric Acid

Kidney

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No Fasting Required

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Quantifies uric acid levels; elevated in gout or kidney stones.

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Uric Acid Test - Comprehensive Medical Information Guide

Why is it done?
- Measures the level of uric acid in the blood, which is a waste product produced when the body breaks down purines from food and cell metabolism
- Screen for and diagnose gout, a painful inflammatory arthritis caused by uric acid crystal deposition in joints
- Monitor patients at risk for hyperuricemia or those with a family history of gout
- Evaluate kidney function, as kidneys are responsible for excreting uric acid
- Assess tumor lysis syndrome risk in cancer patients undergoing chemotherapy
- Monitor patients with hyperuricemia, hypoxanthine-guanine phosphoribosyltransferase (HGPRT) deficiency, or other metabolic disorders
- Typically performed as part of routine metabolic panel, during acute gout attacks, or when investigating joint pain and inflammation
Normal Range
- Adult Males: 3.5 to 7.2 mg/dL (or 210 to 429 μmol/L)
- Adult Females: 2.6 to 6.0 mg/dL (or 155 to 357 μmol/L)
- Children: 2.0 to 6.2 mg/dL (varies by age)
- Units of Measurement: mg/dL (milligrams per deciliter) or μmol/L (micromoles per liter)
- Interpretation - Normal: Results within the normal range indicate adequate renal clearance and metabolism of uric acid; low risk of gout or kidney-related hyperuricemia
- Interpretation - High (>7.2 mg/dL for males, >6.0 mg/dL for females): Hyperuricemia; increased risk of gout attacks, kidney stones, and potential cardiovascular complications
- Interpretation - Low (<2.6 mg/dL for females, <3.5 mg/dL for males): Hypouricemia; may indicate excessive uric acid excretion, certain genetic disorders, or uric acid-lowering medication overdose
- Borderline Elevated: 6.5-7.2 mg/dL in males or 5.5-6.0 mg/dL in females may warrant lifestyle modifications and further monitoring
Interpretation
- Elevated Uric Acid (Hyperuricemia): Indicates either overproduction or underexcretion of uric acid; associated with gout risk, urate nephropathy (kidney damage), and uric acid kidney stones
- Significantly Elevated (>10 mg/dL): May indicate acute leukemia, lymphoma, myeloproliferative disorders, or tumor lysis syndrome; requires immediate clinical intervention
- Moderately Elevated (7.3-10 mg/dL): Increased risk of acute gout attacks; suggests need for uric acid-lowering therapy and dietary modifications
- During Acute Gout Attack: Uric acid levels may paradoxically be normal or only mildly elevated; testing is most useful between attacks or after symptoms resolve
- Low Uric Acid (Hypouricemia): Rare in general population; may indicate xanthine oxidase deficiency, severe liver disease, or medications that increase urinary excretion (allopurinol, febuxostat, probenecid)
- Factors Affecting Results: Diet high in purines (red meat, organ meats, certain seafood, alcohol); recent exercise; dehydration; recent illness or fever; medications (diuretics, aspirin, chemotherapy); genetic predisposition; renal function; age and gender differences
- Clinical Significance: A single elevated result may not be diagnostic; repeated measurements or 24-hour urine uric acid test may be needed; must correlate with clinical symptoms, joint examination, and imaging findings
Associated Organs
- Primary Organ Systems: Kidneys (primary excretion site), joints (site of crystal deposition), liver (site of purine metabolism)
- Gout (Gouty Arthritis): Most common purine metabolism disorder; caused by monosodium urate crystal deposition in joints and soft tissues; presents with acute inflammatory attacks, typically affecting first metatarsophalangeal joint
- Chronic Tophaceous Gout: Long-standing hyperuricemia resulting in tophi (deposits of monosodium urate crystals) in ears, fingers, and other tissues; causes chronic joint damage and deformity
- Uric Acid Nephropathy: Kidney damage from uric acid crystal deposition in renal tubules; can lead to acute kidney injury or chronic kidney disease; particularly common in tumor lysis syndrome
- Uric Acid Kidney Stones: Formation of uric acid crystals in the urinary system; associated with hematuria, flank pain, and potential urinary obstruction
- Tumor Lysis Syndrome: Life-threatening complication following chemotherapy in rapidly dividing tumors (leukemia, lymphoma); massive cell death releases intracellular contents including uric acid, causing hyperuricemia, hyperkalemia, hyperphosphatemia, and acute kidney injury
- Associated Medical Conditions: Chronic kidney disease, hypertension, metabolic syndrome, obesity, Type 2 diabetes mellitus, hyperlipidemia, psoriasis, hemolytic anemia, polycythemia vera, myeloproliferative disorders, and heart failure
- Potential Complications: Recurrent joint inflammation and arthritis; permanent joint damage; increased cardiovascular disease risk; chronic renal disease progression; acute kidney injury; urinary complications; secondary infection of tophi
Follow-up Tests
- 24-Hour Urine Uric Acid: Determines whether hyperuricemia is due to overproduction (>800 mg/24h) or underexcretion (<400 mg/24h); helps guide treatment selection
- Comprehensive Metabolic Panel: Includes electrolytes, kidney function (creatinine, BUN), liver function tests; essential for assessing renal clearance and metabolic abnormalities
- Serum Creatinine and eGFR: Assess kidney function; important because kidney disease is both a cause and consequence of hyperuricemia
- Joint Fluid Analysis (Synovial Fluid): Gold standard for gout diagnosis; demonstrates intracellular monosodium urate crystals (needle-shaped, negatively birefringent) under polarized light microscopy
- X-Ray or Ultrasound of Affected Joints: Evaluates for joint damage, tophi, or other abnormalities; ultrasound can demonstrate uric acid crystal deposits
- Lipid Panel: Hyperuricemia is associated with dyslipidemia and cardiovascular disease; lipid assessment important for risk stratification
- Fasting Glucose or Hemoglobin A1C: Hyperuricemia strongly associated with Type 2 diabetes and insulin resistance
- 24-Hour Urinary pH: Acidic urine (<5.5) promotes uric acid crystallization and stone formation; alkaline urine promotes uric acid dissolution
- Monitoring Frequency for Gout Patients: Baseline level before therapy; recheck 2-4 weeks after initiating uric acid-lowering therapy to confirm target level (<6 mg/dL); then monitor annually or every 3-6 months if not at target
- Monitoring in Cancer Patients: Baseline before chemotherapy; frequent monitoring during and immediately after treatment (daily to every few days); continues until levels normalize post-chemotherapy
Fasting Required?
- Fasting Requirement: No - fasting is NOT required for uric acid testing
- Blood Draw Timing: Can be performed at any time of day; uric acid levels are relatively stable regardless of fasting state
- Important Timing Consideration - Acute Attack: Avoid testing during acute gout flare-up as levels may be falsely normalized; wait at least 2-3 weeks after attack resolution for accurate baseline measurement
- Medications to Avoid/Medication Considerations: Do NOT stop regular medications without consulting physician; however, certain medications affect uric acid levels: loop diuretics and thiazide diuretics increase levels; low-dose aspirin increases levels; high-dose aspirin decreases levels; allopurinol and febuxostat decrease levels; discuss any medication adjustments with healthcare provider
- Dietary Considerations Before Testing: For most accurate baseline results, avoid purines 24 hours before test if possible; minimize alcohol consumption (particularly beer) 48 hours before testing as it can elevate uric acid; maintain normal hydration; avoid excessive exercise immediately before test as strenuous activity can elevate levels
- General Patient Preparation: Arrive well-hydrated; wear loose, comfortable clothing for easy venipuncture; inform phlebotomist of recent illness or fever; inform healthcare provider of all current medications and supplements; report recent chemotherapy or acute illness that may elevate uric acid
- Specimen Handling: Blood sample collected in standard tube without anticoagulant (serum) or sometimes EDTA tube depending on lab; sample should be transported promptly to laboratory; refrigeration may be needed if processing is delayed; uric acid is stable in serum but can increase if sample sits at room temperature

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