What causes hyperuricemia (elevated uric acid levels)?

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From the Guidelines

Increased uric acid levels can be caused by factors such as chronic kidney disease, overweight, certain medications (including diuretics, low-dose aspirin, cyclosporine, and tacrolimus), and consumption of excess alcohol, non-diet sodas, meat, and shellfish. These factors are identified as risk factors for chronic hyperuricaemia in individuals with gout, as stated in the 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout 1. Some key points to consider include:

  • Chronic kidney disease (CKD) as a risk factor for hyperuricaemia
  • The role of overweight and obesity in increasing uric acid production and decreasing elimination
  • Medications such as diuretics, low-dose aspirin, cyclosporine, and tacrolimus that can raise uric acid levels
  • Lifestyle factors like excess alcohol consumption, particularly beer and spirits, and diet, including non-diet sodas, meat, and shellfish, which can contribute to elevated uric acid levels 1. It is essential to identify and address these modifiable risk factors to manage hyperuricaemia and prevent complications like gout and kidney stones.

From the FDA Drug Label

Hyperuricemia may be primary, as in gout, or secondary to diseases such as acute and chronic leukemia, polycythemia vera, multiple myeloma, and psoriasis It may occur with the use of diuretic agents, during renal dialysis, in the presence of renal damage, during starvation or reducing diets, and in the treatment of neoplastic disease where rapid resolution of tissue masses may occur.

The following can cause increased uric acid levels:

  • Primary hyperuricemia, as in gout
  • Secondary hyperuricemia due to diseases such as:
    • Acute and chronic leukemia
    • Polycythemia vera
    • Multiple myeloma
    • Psoriasis
  • Use of diuretic agents
  • Renal dialysis
  • Presence of renal damage
  • Starvation or reducing diets
  • Treatment of neoplastic disease with rapid resolution of tissue masses 2

From the Research

Causes of Increased Uric Acid Levels

  • Increased production of uric acid 3
  • Decreased excretion of uric acid 3
  • Certain medications 3
  • Alcohol consumption 3
  • Kidney disease 3, 4, 5, 6
  • High blood pressure 3, 6
  • Hypothyroidism 3
  • Pesticide exposure 3
  • Obesity 3, 4, 7
  • Metabolic syndrome 4, 7, 6
  • Diabetes 6
  • Certain dietary patterns, such as an animal-based diet 7

Dietary Factors

  • A plant-based dietary pattern is associated with decreased uric acid levels and a reduced risk of hyperuricemia 7
  • An animal-based dietary pattern is associated with an increased risk of hyperuricemia 7
  • A mixed dietary pattern may have varying effects on uric acid levels and hyperuricemia, depending on the specific foods and nutrients consumed 7

Other Factors

  • Genetic variabilities and epigenetic changes can contribute to hyperuricemia 4
  • Gut microbiota and vitamin D levels may also play a role in uric acid metabolism and hyperuricemia 4

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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