From the Research
The management of hypouricemia should focus on addressing the underlying cause, with hydration and urinary alkalization recommended to protect kidney function, and in some cases, an xanthine oxidoreductase inhibitor may be considered to reduce oxidative stress, as suggested by the most recent study 1. The approach to managing hypouricemia involves identifying whether the condition is due to overexcretion or underproduction of uric acid, with renal hypouricemia (RHU) being a significant concern due to its association with exercise-induced acute kidney injury and urolithiasis 2. Key considerations in the management of hypouricemia include:
- Assessing for and managing underlying conditions that may be contributing to the hypouricemia, such as genetic defects in uric acid transporters or certain medications that can induce hypouricemia 3, 4.
- Hydration is crucial, and patients should be advised to increase their fluid intake to help prevent kidney stones and maintain renal function, unless contraindicated by heart or kidney failure.
- Urinary alkalization may also be beneficial in preventing kidney stones and reducing the risk of acute kidney injury in patients with RHU, as suggested by the study 1.
- In cases where hypouricemia is suspected to be caused by a genetic defect, genetic testing may be necessary to confirm the diagnosis, and a "wait-and-see" approach with supportive therapy may be appropriate, as indicated by the case report and review of the literature 5.
- Medications that can induce hypouricemia, such as urate-lowering therapies, should be used with caution and monitored closely to avoid overtreatment and potential kidney damage 3, 4. Regular monitoring of kidney function, urine output, and serum uric acid levels is essential to guide ongoing management and prevent potential complications associated with hypouricemia, as highlighted by the recent studies 1, 5.