From the Guidelines
Hyperuricemia is primarily caused by a combination of factors including diet, genetic predisposition, obesity, certain medications, and underlying medical conditions such as kidney disease, as identified in the most recent guidelines from the European League Against Rheumatism 1. The causes of hyperuricemia can be multifaceted, involving:
- Dietary factors, such as consumption of purine-rich foods (red meat, organ meats, seafood, and alcohol)
- Genetic factors affecting uric acid metabolism
- Obesity
- Certain medications (diuretics, low-dose aspirin, and some immunosuppressants)
- Medical conditions (kidney disease, diabetes, metabolic syndrome, and hypothyroidism)
- Dehydration, which can concentrate uric acid in the blood
To manage elevated uric acid levels, the following strategies are recommended:
- Dietary modifications, including limiting purine-rich foods and reducing alcohol consumption, particularly beer
- Maintaining adequate hydration
- Weight loss for overweight individuals
- Regular exercise to enhance insulin sensitivity and reduce inflammation
- Medications such as allopurinol, febuxostat, or probenecid may be prescribed for persistent hyperuricemia, especially in patients with gout or kidney stones, as suggested by the American College of Rheumatology guidelines 1.
It is essential to address these factors to prevent complications associated with untreated hyperuricemia, such as gout, kidney stones, and potential contributions to cardiovascular disease. The most recent and highest quality evidence should guide clinical decision-making to prioritize morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
The etiology of this hyperuricemia is the overproduction of uric acid in relation to the patient's ability to excrete it 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 cause of hyperuricemia (elevated uric acid) is the overproduction of uric acid in relation to the patient's ability to excrete it. This can be primary, as in gout, or secondary to various diseases, such as:
- Acute and chronic leukemia
- Polycythemia vera
- Multiple myeloma
- Psoriasis It can also occur due to:
- Diuretic agents
- Renal dialysis
- Renal damage
- Starvation or reducing diets
- Treatment of neoplastic disease 2
From the Research
Causes of Hyperuricemia
- Hyperuricemia may occur when there is an excess of uric acid in the blood 3
- It may result from increased production or decreased excretion of uric acid 3
- Elevated uric acid levels are a risk factor for gout, and various risk factors, including some medications, alcohol consumption, kidney disease, high blood pressure, hypothyroidism, and pesticide exposure, as well as obesity, are associated with an elevated risk of hyperuricemia 3
Risk Factors
- Genetic predispositions, comorbid medical conditions, nutritional choices, and environmental factors increasingly recognize the multifactorial etiology of the disease 4
- Maternal hyperuricemia during pregnancy and hyperuricemia early in life are likewise independent risk factors for hypertension 5
- Western diet, insulin resistance, and renal dysfunction can also contribute to hyperuricemia 5
Biological Processes
- Uric acid can affect kidneys through different mechanisms at glomerular, tubulo-interstitial and vascular level 6
- Xanthine oxidase-related oxidative stress may also induce endothelial dysfunction and renal vasoconstriction 5
- Hyperuricemia is involved in a variety of biological processes and signaling pathways 3
Associated Conditions
- Hyperuricemia is a complication often seen in patients with chronic and acute renal disease 6
- Chronic hyperuricemia is also associated with chronic tubulo-interstitial disease with glomerular sclerosis, and renal dysfunction 6
- Hyperuricemia affects one out of five adults as a result of the Western diet, insulin resistance, and renal dysfunction 5