Treatment of High Uric Acid Levels

Hyperuricemia is defined as a plasma uric acid concentration which is more than >6.8 mg/dL. Hyperuricemia does not necessarily represent a disease, nor is it a specific indication for therapy. The decision to treat depends on the cause and the potential consequences of the hyperuricemia in each individual.

The problems related to high uric acid levels are gout, renal stones due to uric acid and urate anduric acid causing renal damage. Hyperuricemia is present in around 5% of the population and in up to 25% of hospitalized individuals, the majority of whom have no symptoms, neither are they at risk to develop a uric acid-related disease. In the past, the association of hyperuricemia with cardiovascular disease and renal failure led to the use of urate-lowering agents for patients with asymptomatic hyperuricemia.

This practice is no longer recommended except for individuals receiving cytolytic therapy for neoplastic disease, in which treatment is given in an effort to prevent uric acid nephropathy. Because hyperuricemia can be a component of the metabolic syndrome, its presence is an indication to screen for and aggressively treat any accompanying obesity, hyperlipidemia, diabetes mellitus, or hypertension.

Hyperuricemic individuals are at risk to develop gouty arthritis, especially those with higher serum urate levels. However, most hyperuricemic persons never develop gout and prophylactic treatment is not indicated. Furthermore, neither structural kidney damage nor tophi are identifiable before the first attack.

Reduced renal function cannot be attributed to asymptomatic hyperuricemia, and treatment of asymptomatic hyperuricemia does not alter the progression of renal dysfunction in patients with renal disease. Increased risk of stone formation in those with asymptomatic hyperuricemia is not established.

Thus, because treatment with specific antihyperuricemicagents entails inconvenience, cost, and potential toxicity, routine treatment of asymptomatic hyperuricemia cannot be justified. In addition, routine screening for asymptomatic hyperuricemia is not recommended. Ifhyperuricemia is diagnosed, however, the cause should be determined. Causal factors should be corrected if the condition is secondary, and associated problems such as hypertension, hypercholesterolemia, diabetes mellitus, and obesity should be treated.

Dr. Rakesh Periwal