From the Guidelines
Hypouricemia, or low uric acid, is primarily caused by genetic disorders, certain medications, and kidney diseases, and its management should focus on addressing the underlying cause to prevent associated morbidity and mortality. The causes of hypouricemia can be multifactorial, including genetic disorders such as autosomal dominant tubulointerstitial kidney disease (ADTKD) 1. In ADTKD, mutations in genes like UMOD, MUC1, HNF1B, and REN can lead to hypouricemia due to impaired uric acid reabsorption in the kidneys. Some key points to consider in the management of hypouricemia include:
- Discontinuing medications that lower uric acid levels, such as allopurinol or febuxostat, if possible 1
- Treating underlying conditions like malabsorption disorders or Wilson's disease that can cause hypouricemia
- Managing kidney diseases like ADTKD with careful monitoring of kidney function and avoidance of medications that can exacerbate kidney damage, such as nonsteroidal anti-inflammatory drugs (NSAIDs) 1
- Maintaining proper hydration to prevent kidney complications, especially in patients with symptomatic low uric acid It is essential to note that hypouricemia can increase the risk of certain health issues, including neurological problems, kidney dysfunction, and increased susceptibility to diseases like Parkinson's disease, multiple sclerosis, and Alzheimer's disease. Therefore, prompt diagnosis and management of the underlying cause are crucial to prevent these complications and improve quality of life.
From the Research
Causes of Hypouricemia
- Abnormal serum levels of uric acid are due to alterations in production or excretion 2
- Fractional excretion of uric acid is helpful in determining the underlying etiology of hypouricemia or hyperuricemia in children 2
- Abnormalities in the molecular mechanisms that control renal uric acid tubular transport are implicated in various disorders associated with abnormal uric acid levels, including hypouricemia 2
- A reduced uric acid concentration has been linked to multiple sclerosis, Parkinson's disease, Alzheimer's disease, and optic neuritis 3
- Abnormal elevation or reduction of UA levels has been linked to some pathological status, also known as U-shaped association, implying that the physiological levels of UA regulated by multiple enzymes and transporters are crucial for the maintenance of health 4
- The protective potential of UA has also been proposed in aging and some diseases, suggesting that hypouricemia may be associated with certain disease states 4
Disease States Associated with Hypouricemia
- Multiple sclerosis 3
- Parkinson's disease 3
- Alzheimer's disease 3
- Optic neuritis 3
- Certain pathological status due to abnormal elevation or reduction of UA levels 4