Is a serum uric acid level of 386 μmol/L within the normal range?

Serum Uric Acid Level Assessment

A serum uric acid level of 386 μmol/L is above the recommended target of <360 μmol/L and indicates hyperuricemia that requires monitoring and potential intervention. 1

Normal Range and Clinical Significance

• Serum uric acid levels should be maintained below 360 μmol/L (6 mg/dL) in all patients with gout or hyperuricemia to prevent crystal formation and deposition 1
• For patients with severe gout (tophi, chronic arthropathy, frequent attacks), a lower target of <300 μmol/L (5 mg/dL) is recommended until clinical remission is achieved 1
• Traditional "normal ranges" of 3.5-7.2 mg/dL for men and 2.6-6.0 mg/dL for premenopausal women are based on population distributions rather than clinical outcomes 2
• Your level of 386 μmol/L exceeds the therapeutic target of <360 μmol/L, placing you at increased risk for urate crystal deposition 1

Clinical Implications

• Hyperuricemia (>360 μmol/L) is associated with:
  • Increased risk of gout development 1
  • Silent monosodium urate crystal deposition that may lead to joint damage even without symptomatic gout 2
  • Higher risk of cardiovascular mortality, particularly in patients with type 2 diabetes 3
  • Potential contribution to kidney disease progression 4
  • Increased prevalence of cardiac conduction defects 5

Monitoring and Management Recommendations

• Regular monitoring of serum uric acid levels is essential to maintain levels below 360 μmol/L 1

• If you have diagnosed gout:

  • Urate-lowering therapy should be adjusted to achieve and maintain serum uric acid <360 μmol/L 1
  • All urate-lowering therapies should be started at a low dose and then titrated upward until the target is reached 1
  • Allopurinol is recommended as first-line therapy, starting at 100 mg/day and increasing by 100 mg increments every 2-4 weeks as needed 1
  • Serum uric acid levels <360 μmol/L should be maintained lifelong 1, 6

• If you don't have gout but have hyperuricemia:

  • Lifestyle modifications are recommended, including weight loss if appropriate, limiting alcohol intake (especially beer and spirits), avoiding sugar-sweetened drinks, and reducing intake of meat and seafood 1
  • Regular monitoring of kidney function is important as hyperuricemia and kidney dysfunction have a bidirectional relationship 4

Important Considerations

• Serum uric acid may be temporarily lower during acute inflammatory episodes, so a single measurement may not reflect your usual level 1
• The relationship between hyperuricemia and disease is not limited to crystal deposition but appears to have direct pathophysiological effects even at levels below saturation point 2
• Renal function should be assessed and monitored regularly in all patients with hyperuricemia 1

Common Pitfalls to Avoid

• Assuming that absence of gout symptoms means hyperuricemia is benign - silent crystal deposition and other metabolic effects can occur 2
• Relying on traditional "normal ranges" rather than evidence-based therapeutic targets (<360 μmol/L) 1, 2
• Failing to consider comorbidities that may be influenced by or contribute to hyperuricemia 1
• Discontinuing monitoring or treatment once symptoms resolve, as lifelong management is typically required 6