From the Guidelines
Yes, having just one kidney can potentially lead to higher uric acid levels, as the single kidney must handle all the filtering work normally done by two kidneys, which can reduce the efficiency of uric acid excretion. Uric acid is a waste product that needs to be filtered from the blood and excreted through urine. With reduced kidney function, uric acid may accumulate in the bloodstream, leading to elevated levels. This is particularly concerning for individuals who already have risk factors for high uric acid, such as consuming a diet high in purines (found in red meat, organ meats, and certain seafood), being overweight, or having certain medical conditions.
Some key points to consider:
- According to the KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease 1, people with CKD and symptomatic hyperuricemia should be offered uric acid–lowering intervention.
- The guideline also suggests that nonpharmacological interventions, such as limiting alcohol, meats, and high-fructose corn syrup intake, may help prevent gout.
- If you have one kidney and are concerned about uric acid levels, it's advisable to maintain good hydration by drinking plenty of water, limit alcohol consumption, maintain a healthy weight, and follow a low-purine diet.
- Regular monitoring of kidney function and uric acid levels through blood tests is important, and medications like allopurinol or febuxostat may be prescribed to help lower uric acid production, though dosing may need adjustment for single-kidney patients due to altered kidney function.
- It's also important to note that diuretics should be used with caution in patients with kidney disease, as they may aggravate hyperuricemia and volume depletion, as mentioned in the autosomal dominant tubulointerstitial kidney disease guideline 1.
Overall, having one kidney can increase the risk of high uric acid levels, and it's essential to take preventive measures and monitor kidney function and uric acid levels regularly to prevent complications.
From the Research
Uric Acid and Kidney Function
- Uric acid is excreted predominantly by the proximal tubules in the kidneys 2
- Abnormal serum levels of uric acid can be due to alterations in production or excretion, and fractional excretion of uric acid can help determine the underlying cause of hypouricemia or hyperuricemia 2
Relationship Between Uric Acid and Kidney Disease
- Hyperuricemia is often seen when kidney function declines, and elevated uric acid levels may play a role in the initiation and progression of kidney disease 3
- The relationship between uric acid and kidney disease is complex, and uric acid may be both a marker and a potential therapeutic target in kidney disease 2, 3
- Observational studies suggest a relationship between uric acid levels and incident chronic kidney disease (CKD), but the evidence is not conclusive 3, 4
Impact of Reduced Kidney Function on Uric Acid Levels
- Having one kidney may lead to reduced kidney function, which can result in elevated uric acid levels 3, 4
- The kidneys play a major role in regulating serum uric acid levels, and approximately two-thirds of uric acid produced in humans is excreted by the kidneys 4
- Variations in renal urate handling can influence the risk of gout and other disorders associated with abnormal uric acid levels 2, 4
Treatment of Hyperuricemia in Patients with Chronic Kidney Disease
- Urate-lowering therapy (ULT) may help reduce uric acid levels and slow the progression of CKD 5, 6
- Febuxostat and allopurinol are two common ULT medications, and febuxostat may be more effective in reducing uric acid levels in patients with CKD 5, 6
- However, the evidence is not conclusive, and further studies are needed to determine the effectiveness of ULT in patients with CKD and hyperuricemia 3, 5