Why Uric Acid Is Bad News For Your Health

Hyperuricemia is a dirty word: here is how it damages your heart and kidneys

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Uric acid is a substance found in the blood. It gets there when "purines" which are one of the building blocks of your DNA, are broken down. This is normal and hence it is ok to see some amount of uric acid in the blood. However certain disease conditions, foods, and medications can also raise blood uric acid levels to abnormal highs. High uric acid levels, or "hyperuricemia", may lead to gout, but is now being increasingly seen to have a possible causal relationship with health conditions including kidney and heart disease. 


Chronic Kidney Disease (CKD) is one of the disease conditions that can increase the level of uric acid in your blood. Uric acid level increases usually due to two reasons. Either you are making too much of it (overproduction), or you are not excreting it well enough (underexcretion). Kidney disease is a state where you could have uric acid underexcretion from the kidneys, and hence it is not surprising to see high uric acid levels in patients suffering from CKD. 

However, the relationship between high uric acid levels and CKD is not that simple. It is in fact a classic chicken-and-egg problem. High uric acid level can itself can be a risk factor for CKD.


Traditionally, high uric acid causing kidney disease was referred to as "urate nephropathy". Uric acid stones can also form in the urinary tract when its levels are high in the urine.

But in general, although we know that elevated uric acid level is associated with kidney disease, a causal relationship has never been established. However this paradigm is being challenged.

New data emerging over the last decade have forced us to take another look at the possibility of a causal relationship between high uric acid levels and chronic kidney disease (CKD).

A steady stream of epidemiological data has shown that elevated serum uric acid level is an independent risk factor for incident kidney disease in the general population (see here as well).

The next logical question that then arises is, “should we be treating high uric acid level in an otherwise perfectly normal patient”?


Asymptomatic hyperuricemia implies high uric acid levels in patients who otherwise do not have gout or uric acid kidney stones or urate nephropathy? The question is, given the information above, would it make sense to treat it in order to prevent kidney or heart disease?  Would you reduce the progression of kidney disease by doing so?  

In an attempt to answer this question, we saw a randomized study come out in 2010 which showed that treatment of high uric acid using a medication called allopurinol could prevent a decline in kidney function and reduce risk of heart disease. Further studies are under way but could this be compelling evidence in support of uric acid lowering therapy to be considered an intervention for slowing CKD and cardiovascular disease progression? Just like we lower cholesterol in people with heart disease, maybe we should be lowering uric acid as well.


I expect this to become standard medical therapy with the way things appear to be headed. Until then, it is left to the individual patient/physician to consider allopurinol in patients at risk of heart and kidney disease. A low purine diet might help in case you are not in the mood for adventure! 

Food for thought. Talk about it with your nephrologist

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