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Hyperuricosuria - Causes, Symptoms, Diagnosis, and Treatment

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Hyperuricosuria is when excessive uric acid is excreted in the urine. It can occur in both men and women. Read the article to learn more.

Published At November 23, 2022
Reviewed AtNovember 23, 2022

What Is Hyperuricosuria?

Uric acid is a substance that forms when purines are used by the body cells to carry out their activities. Purine is a chemical substance in the body or obtained from food items like dried beans, peas, beer, and anchovies. Normally, 300 to 400 milligrams of uric acid is produced daily, most of which is made by the liver. An enzyme known as uricase converts uric acid to allantoin, but this enzyme is inactive in humans. Hence, the end-product formed as a result of purine metabolism is uric acid. The kidneys maintain the levels of uric acid in the blood. When the uric acid reaches the filtration units of the kidneys, it is reabsorbed, and only ten percent of it is allowed to be excreted. Some uric acid goes into the intestine and converts into ammonia. This ammonia is utilized by the bacteria of the gut for metabolic activities. However, the problem arises when more than 750 to 800 milligrams of uric acid pass into the urine. This condition is known as hyperuricosuria and causes severe problems in the urinary tract. Uric acid might get deposited in the bones, joints, and other organs and cause severe complications.

What Are the Causes of Hyperuricosuria?

If the uric acid is in excess in the urine, the risk of calcium oxalate and uric acid stones (uroliths) increases. It is because the urine becomes saturated with monosodium urate that initiates the formation of calcium oxalate stones. The causes of hyperuricosuria are listed below:

  1. Gouty Diathesis - Gouty is a form of arthritis that occurs due to the deposition of uric acid in bones and joints. When uric acid stones form in people suffering from gout, the condition is known as gouty diathesis. However, the exact cause of uric acid stones in these patients is still unknown, but the urine shows a low pH (potential of hydrogen) upon examination.

  2. Purine-Rich Diet - Purine is a chemical substance responsible for the formation of uric acid. If purine-rich food items like meat, fish, anchovy, and alcohol are consumed in excess, more uric acid builds up in the body resulting in hyperuricosuria.

  3. Diabetes - The exact relation between diabetes and hyperuricosuria is unknown. However, diabetics tend to develop acidic urine and uric acid stones due to insulin resistance. In addition, as ammonia is not produced in sufficient quantities, the uric metabolism gets impaired, resulting in hyperuricosuria.

  4. Crohn’s Disease - It is a type of inflammatory bowel disease that causes severe abdominal pain, diarrhea, fatigue, and weight loss. Patients suffering from this disease tend to produce less urine and lose essential fluids and electrolytes. In addition, the person becomes dehydrated due to Crohn’s disease, and the functions of the kidneys become impaired.

  5. Genetic Disorders - Patients suffering from genetic disorders like Lesch-Nyhan syndrome and type 1 collagen disorders tend to produce uric acid in large amounts. As a result, large quantities of it get excreted in the urine resulting in hyperuricosuria.

  6. Medications - Certain medications interfere with the reabsorption of uric acid in the kidneys. These drugs do not allow the kidneys to reabsorb uric acid. As a result, a large quantity of uric acid passes from the kidneys to the urine, and the risk of stone formation increases.

  7. Malignancy - People with cancer and undergoing radiotherapy or chemotherapy tend to suffer from hyperuricosuria.

What Are the Signs and Symptoms of Hyperuricosuria?

The symptoms of hyperuricosuria appear when the uric acid crystals combine with calcium and form stones. The signs and symptoms of hyperuricosuria are listed below:

  • Pain - The patient experiences severe pain in the lower back and sides (flank). The pain slowly radiates to the abdomen and the pubic region. As the pain starts suddenly, it does not subside even if the patient changes his position. Patients suffering from renal colic (severe kidney pain) find it difficult to stay still.

  • General Problems - Vomiting, nausea, and fever are commonly seen if the patient develops urinary tract infections due to stones.

  • Urinary Tract Problems - If the stone is present near the urinary bladder, the following symptoms are usually seen:

    • The presence of blood in the urine, also known as hematuria, is commonly seen due to kidney stones.

    • The urine flow becomes restricted.

    • Pain and a burning sensation while urinating is the most common finding.

    • The urine smells bad and looks cloudy.

    • Feeling the desire to urinate frequently.

What Methods Are Used to Diagnose Hyperuricosuria?

The diagnosis of hyperuricosuria is based on medical history, physical examination, laboratory tests, and imaging tests. The diagnostic methods have been described below:

  1. Medical History - Medical history plays an important role in patients suffering from hyperuricosuria. It gives information about the patient's general health, symptoms, duration of onset, family history, drug history, and other conditions the patient is suffering from. For example, hyperuricosuria can be suspected if the patient has a history of diabetes or gout, is on medications like Probenecid or Sulfinpyrazone, and consumes a purine-rich diet.

  2. Physical Examination - The patient will be in distress due to pain during the physical examination. If he is suffering from renal colic along with hyperuricosuria, the patient will not be able to sit or stand still. The doctor will also check for tenderness between the 12th rib and spine (costovertebral angle).

  3. Laboratory Tests - The following laboratory tests are usually recommended to diagnose hyperuricosuria:

    • Urinalysis - In this test, the patient collects the urine in a container or a sterile bag provided by the hospital. The urine sample is examined in the laboratory microscopically, visually, or by using a dipstick. First, the urine is tested with a dipstick which changes color if the pH is acidic. Acidic urine is indicative of uric acid stones. Next, the urine sample is examined under the microscope to detect pus cells, bacteria, blood, and crystals. If the urine shows the presence of diamond-shaped crystals, uric acid stones are present.

    • 24-Hour Urine Test - As the name suggests, the patient must collect urine in a container throughout the day. The urine sample is sent to the laboratory for examination under a microscope the next day. This test is only recommended for patients who develop stones repeatedly.

    • Blood Test - The doctor might ask the patient to undergo a blood test to check sodium, potassium, calcium, and uric acid levels. If the uric acid levels are high, the person might suffer from gout or hyperuricosuria.

    • Stone Analysis - The patient is given a container and a strainer. The urine is supposed to be collected in the container and filtered through the strainer. If stones are present, they appear as small particles on the strainer. It is then sent to the laboratory to check if they are uric acid stones.

  4. Imaging Tests - The following imaging tests are usually recommended to check the presence of stones:

    • Computerized Tomography (CT) Scans - It is one of the most specific and highly recommended tests to diagnose uric acid stones. This procedure provides three-dimensional (3D) images of the body's internal organs. The patient is laid on a table that slides into a tunnel-like device where the X-rays are taken. The uric acid stones appear bright white on the images obtained after the scan.

    • Ultrasound - It is a diagnostic test that helps to obtain images of the body's internal organs without exposing the patient to X-rays. The advantage of the procedure is that the patient is not exposed to the X-rays, so it can be safely used on children and pregnant females. The patient is laid on a table, and the sound waves are sent to the body with the help of a transducer. The doctor moves the transducer over the abdomen, and the images are obtained on the computer screen. The ultrasound helps to check kidney stones and other problems in the urinary system.

How Is Hyperuricosuria Managed?

The treatment depends upon the causes and severity of the condition. The treatment options have been described below:

  • Medications - Patients suffering from hyperuricosuria have acidic urine, increasing the risk of stone formation. Therefore, it is important to increase the urine's pH (potential of hydrogen) to make it alkaline. Potassium citrate therapy is the most effective medication used to treat uric acid stones. Sodium and potassium bicarbonate salts also work to alkalinize the urine. Theobromine is also an effective agent that inhibits the growth of uric acid crystals. Allopurinol is also recommended in hyperuricosuria. Ultrasound and 24-hour urine tests are done to check the effectiveness of these medications.

  • Water - The patient needs to drink sufficient water daily to flush out the waste products from the body. Water does not allow the buildup of uric acid in the blood.

  • Lifestyle Changes - Patients suffering from diabetes and other metabolic disorders need to exercise regularly to maintain a healthy weight. Consumption of salty and purine-rich foods should be avoided.

  • Surgery - If the stones are large and block the urine flow, surgical intervention is required to remove them. The surgical options have been described below:

    • Percutaneous Nephrolithotomy: If the stone has become very large and the pain is unbearable, an incision is made in the back region to remove the stones, usually greater than two centimeters. A tube is passed through the incision with a telescope to remove the stone directly or break it down into smaller fragments for removal.

    • Ureteroscopy - In this procedure, a small telescope-like instrument known as a ureteroscope is inserted into the urinary bladder through the urethra. The stones can be easily located with the help of a camera. They are removed directly or broken into fragments to allow them to pass through the urine.

What Are the Complications of Hyperuricosuria?

Hyperuricosuria can cause severe complications if left untreated for a long time. The complications of hyperuricosuria are listed below:

  1. Hydronephrosis - It is a condition in which the kidneys swell due to the backflow of urine. Suppose the uric acid stone is large and blocks the urine flow, the pressure on the kidneys increases, resulting in swelling and permanent failure.

  2. End-Stage Renal Disease - When uric acid stones repeatedly form, the kidneys fail to function permanently. It is known as an end-stage renal disease; the patient must be on dialysis or undergo a kidney transplant.

  3. Urinary Tract Infection - Hyperuricosuria increases the risk of urinary tract infections as the urine remains in the body. The bacteria quickly enter the body and multiply in the urine.

  4. Obstructive Pyelonephritis - It is a life-threatening condition that occurs due to a bacterial infection. The urine needs to be drained from the body at the earliest.

  5. Ureteral Strictures - If the stones travel from the kidneys to the ureters, they become narrow, resulting in ureteral strictures.

  6. Chronic Kidney Disease - If the uric acid levels keep on rising, the kidneys lose their ability to reabsorb them and get damaged permanently.

Conclusion:

Hyperuricosuria is when uric acid is present in large amounts in the urine. Uric acid forms when the body uses purines for various activities. Several causes of hyperuricosuria include gout, genetic disorders, diabetes, and Crohn's disease. Also, a diet rich in purine increases the risk of hyperuricosuria. The patient experiences severe flank pain, which does not subside easily and increases during the day and night. Stones form when uric acid crystals clump together. These stones block the urine flow and interfere with the ability of the kidneys to reabsorb uric acid. Though the condition is serious, it is not incurable. Medications are available that reduce uric acid levels and make the urine's pH (potential of hydrogen) alkaline. The patient need not worry, as surgical intervention is required only when uric acid stones are present. Consult the doctor at the earliest for diagnosis and treatment of the condition.

Frequently Asked Questions

1.

What Are the Drugs That Lead to Hyperuricosuria?

Certain drugs interfere with the reabsorption of uric acid from the kidneys. So the risk of the stone formation increases, and large amounts of uric acid are passed into the urine. The uricosuric drugs atorvastatin, amlodipine, and losartan increase the uric acid levels in the urine.

2.

How High Uric Acid Is Treated?

Potassium citrate therapy is an effective therapy used to treat uric acid stones. Sodium and potassium bicarbonate salts work to alkalize the urine. Theobromine is also an effective agent that inhibits the growth of uric acid crystals. Allopurinol is also recommended in hyperuricosuria. Ultrasound and 24-hour urine tests are done to check the effectiveness of these medications. Consumption of salt and purine-rich foods should be avoided. Plenty of water should be taken to flush out waste products from the body. Water does not allow the build-up of uric acid in the blood. Percutaneous Nephrolithotomy and Ureteroscopy are surgical procedures to remove the stone or break it down into smaller pieces for removal.

3.

What Are the Foods That Reduce Uric Acid?

Uric acid is a product of the digestion of food that contains purine. Some purine-rich foods are alcohol, red meat, dried beans, organ meats, sardines (saltwater fish), beer, and anchovies (saltwater fish).

4.

Is Hyperuricemia Considered a Kidney Problem?

Nearly 70 percent of uric acid is excreted from the kidney.  High serum uric acid is associated with hypertension (high blood pressure). Hyperuricemia is associated closely with chronic kidney disease. It is the major contributing factor to the development of chronic kidney disease. When uric acid continuously accumulates in the body, the kidneys fail to function properly called end-stage renal disease.

5.

How Does Hyperuricemia Damage the Kidneys?

The uric acid stone blocks the urine flow from the kidney, so the pressure in the kidney increases, leading to swelling and permanent kidney failure.

6.

What Are the Complications That Occur Due to High Uric Acid in the Urine?

There is a risk of forming calcium oxalate and uric acid stones (uroliths) if there is excess uric acid in the urine. Because the urine is saturated with monosodium urate, which helps form calcium oxalate stones.

7.

How Can Hyperuricemia Be Cured?

Yes, hyperuricemia is a curable disease. Medications are used to reduce inflammation, swelling, and pain. Drinking plenty of water can help the stone pass out of the body through urine. If the stone is very large, it can be surgically removed through ureteroscopy and percutaneous Nephrolithotomy.

8.

How Hyperuricemia Can Cause Complications in the Body?

High uric acid levels in the blood due to the catabolism of purine nucleotides are called hyperuricemia. Hyperuricemia is associated with risk factors such as blood pressure, dyslipidemia, dysglycemia, and obesity. The daily amount of endogenous and exogenous uric acid is 700 milligrams, balanced by regular output through urine and feces. If the uric acid balance is disrupted, excess uric acid accumulates in the body leading to potentially harmful conditions such as the deposition of uric acid crystals in the joints and tissues, leading to conditions such as nephrolithiasis, gout, and chronic nephropathy.

9.

How Is Uric Acid Removed From the Body?

Naturally, the body filters out uric acid through the urine. The normal level of uric acid is 6.8 mg/dL. If the level exceeds, it can make the urine and blood too acidic. Drinking plenty of water and liquids helps the kidneys to flush out uric acid faster.

10.

Can Uric Acid Be Removed by Lemon?

The lemon juice lowers the uric acid in the blood. It is effective in controlling because it dissolves uric acid and helps in the excretion of it from the body. Drinking a glass of lemonade can help a great deal.

11.

How Curd Is Good for Uric Acid?

Yes, the curd is good for uric acid excretion. Research suggests that curd increases uric acid clearance and excretion through urine.

12.

How and What Are the Exercises That Improve the Symptoms of High Uric Acid in the Body?

Persons suffering from chronic conditions such as diabetes and metabolic disorders should exercise regularly to maintain a healthy balanced life. Exercise, especially yoga, helps reduce stress which is a common trigger for gout attacks.

13.

What Are the Vegetables That Reduce Uric Acid in the Body?

Vegetables such as tomatoes, broccoli, and cucumbers reduce uric acid levels in the body.

14.

How Does Pomegranate Help to Control Uric Acid Levels?

Pomegranate is a good source of citric and malic acid, helps to control uric acid, and helps gout patients get rid of painful and swollen joints.

15.

What Are the Ayurvedic Ways to Reduce the Uric Acid?

Triphala, giloy, neem, bitter gourd, cherries and dark berries, turmeric, and ginger help reduce the uric acid and the inflammation caused by gout.
Source Article IclonSourcesSource Article Arrow
Dr. Samer Sameer Juma Ali Altawil
Dr. Samer Sameer Juma Ali Altawil

Urology

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