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Hyperuricemia and kidney disease can develop in any order. While there is a stronger link between existing kidney disease and the onset of hyperuricemia, high uric acid levels can also harm kidney function, creating a cycle of worsening health. Properly managing hyperuricemia-related Chronic Kidney Disease (CKD) and controlling flares can also help improve kidney function and manage high blood pressure.
Synopsis
- What is Chronic Kidney Disease?
- Understanding Hyperuricemia
- High-Risk Factors for Hyperuricemia
- Causes and Mechanisms of Hyperuricemia in CKD
- Impact of Hyperuricemia on CKD Patients
- Diagnosis of Hyperuricemia in CKD
- Management and Hyperuricemia Treatment Options
- Preventive Strategies to Treat Kidney Disease and Hyperuricemia
What is Chronic Kidney Disease?
Chronic Kidney Disease (CKD) is a gradual, progressive illness that causes renal impairment. However, if one kidney fails, the other may function normally. A kidney may degrade to a certain level of functionality without progressing further. However, the disease may eventually lead to renal failure.
Most people with CKD are unaware of their condition since symptoms rarely develop in the early stages. Usually, when a person detects any symptoms, the condition has progressed. At this stage, kidney damage is permanent.
Symptoms of CKD:
|
High blood pressure |
Dark or bloody urine |
|
Anaemia |
Decreased mental alertness if severe |
|
Edema (Swollen feet, hands, and ankles) |
A loss of appetite |
|
Fatigue |
Persistent itchy skin |
|
Decreased urine output |
Frequent urination, especially at night |
Understanding Hyperuricemia
Hyperuricemia occurs when the bloodstream contains an excessive amount of uric acid. It does not create symptoms, although it might result in gout or kidney stones.
The body creates uric acid due to the breakdown of purine, a molecule found in food and drinks. The kidneys remove uric acid from the circulation. Hyperuricemia is caused by uric acid levels that are too high for the kidneys to function correctly.
Over time, hyperuricemia causes uric acid to clump together in sharp crystals. These crystals can settle in joints and cause gout, a painful form of arthritis, and build up in kidneys and form kidney stones.
The healthy and abnormal uric acid levels for men and women are:
|
Uric Acid Levels |
Men |
Women |
|
Normal |
2.5-7 mg/dL |
1.5-6 mg/dL |
|
Higher |
> 7 mg/dL |
> 6 mg/dL |
|
Lower |
< 2 mg/dL |
< 1.5 mg/dL |
High-Risk Factors for Hyperuricemia
Hyperuricemia can affect anyone at any age but is likely to develop in the following:
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Gender (Being a male increases the risk)
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Obesity
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Regularly drink alcohol
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Consuming high-protein foods often
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Family history of hyperuricemia
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Hypothyroidism
Symptoms associated with high uric acid levels and gout-kidney disease connection may include:
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Painful or swollen joints
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Discolouration or shiny skin around the joints
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Joints feeling warm to the touch
Symptoms of kidney stones that may have been caused by uric acid may include:
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Pain on either side of the back
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Frequent urination
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Urine looks cloudy or contains blood or smells unusual
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Nausea or vomiting
Causes and Mechanisms of Hyperuricemia in CKD
The following outlines the causes and mechanisms contributing to hyperuricemia CKD:
Reduced Renal Excretion
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Impaired Filtration: Chronic Kidney Disease (CKD) reduces the kidneys' ability to filter uric acid, causing it to build up in the blood.
Increased Production of Uric Acid
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Purine Metabolism: CKD can alter purine metabolism, producing more uric acid.
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Cell Turnover: High cell turnover or increased cell death in CKD can raise uric acid levels.
Dietary Factors
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High Purine Intake: Eating foods rich in purines (e.g., red meat, seafood) can increase uric acid levels, worsening hyperuricemia in CKD patients.
Genetic Factors
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Inherited Disorders: Genetic predispositions can affect uric acid metabolism and excretion, making some individuals more prone to hyperuricemia.
Medications
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Diuretics: Commonly prescribed to CKD patients, diuretics can reduce uric acid excretion, leading to hyperuricemia.
Associated Conditions
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Hypertension: Often present in CKD patients, hypertension can impair kidney function and reduce uric acid excretion.
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Obesity and Metabolic Syndrome: These conditions can increase uric acid production and decrease its excretion, contributing to hyperuricemia.
Impact of Hyperuricemia on CKD Patients
Hyperuricemia has significant effects on patients with chronic kidney disease (CKD).
Progression of CKD:
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Renal Damage: High uric acid damages kidneys, causing inflammation and scarring.
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Glomerular Hypertension: Increases blood pressure in kidneys, speeding up damage
Cardiovascular Risk:
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Hypertension: Linked to higher blood pressure, damaging blood vessels and stiffening arteries
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Cardiovascular Disease: Higher risk of heart diseases; promotes inflammation and artery damage
Gout:
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Joint Inflammation: Uric acid crystals in joints cause painful gout
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Recurrent Attacks: Frequent gout attacks due to poor uric acid excretion, leading to chronic joint damage
Metabolic Implications:
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Insulin Resistance: Linked to insulin resistance, complicating diabetes management
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Obesity and Dyslipidemia: Associated with obesity and abnormal lipid levels, worsening CKD
Mortality Risk:
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Increased Mortality: Higher risk of death due to kidney and heart complications from high uric acid
Diagnosis of Hyperuricemia in CKD
An experienced nephrologist in Bangalore may ask for the following tests:
Hyperuricemia Testing
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Physical Exam: Looks for signs and symptoms of Hyperuricemia.
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Medical History: Reviews past health and family history.
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Uric Acid Levels: Checks uric acid in blood and urine.
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Joint Fluid Test: Arthrocentesis (joint fluid aspiration) uses a needle to take fluid from a joint to check for uric acid crystals (the most accurate test).
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Imaging: Ultrasound, CT scan, or MRI may help diagnose gout.
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Uric Acid Blood Test: Measures serum uric acid (sUA). To avoid gout attacks, keep the level below 6.0 mg/dL.
Kidney Disease Testing:
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Glomerular Filtration Rate (GFR): A blood test to see how well kidneys filter waste.
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Albumin-to-Creatinine Ratio (ACR): Urine test to check if protein levels are too high, indicating possible kidney damage.
Management and Hyperuricemia Treatment Options
Hyperuricemia can be managed through dietary changes, medication, and addressing other conditions that increase uric acid levels.
Medications:
Medications for treating high uric acid levels can be categorised based on their use for sudden flares or long-term management. For sudden flares, options include anti-inflammatory drugs, specific medications that need dosage adjustments for CKD patients, and corticosteroids, which can be administered as pills or injections. Long-term treatment aims to lower uric acid levels and prevent future flares and includes various oral medications and intravenous treatments for severe cases that do not respond to oral options. Patients may also use initial preventive medications such as anti-inflammatory drugs, specific gout medications, or corticosteroids when starting long-term therapy
Lifestyle Changes:
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Diet: Avoid or limit high-purine foods and drinks such as organ meats, shellfish, beer, and products with high-fructose corn syrup. Reducing animal protein can lower urine acidity, potentially decreasing the risk of gout flares and kidney stones. Eat plenty of vegetables and fruits.
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Hydration: Drink plenty of water unless your doctor advises otherwise. Continue drinking water at night, as crystals often form more frequently.
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Manage Health Conditions: Treat conditions like kidney disease, obesity, high blood pressure, high blood sugar, and heart disease, as they can increase uric acid and the risk of gout. Review all medications and supplements with your healthcare provider, as some can raise uric acid levels.
Supplements:
Before starting any medication or supplement, consult your doctor, pharmacist, or healthcare team to ensure they won’t harm your kidneys. Be cautious with herbal medicines, as some ingredients can negatively impact kidney function or interact with prescription medications, affecting their efficacy.
Preventive Strategies to Treat Kidney Disease and Hyperuricemia
Implementing these strategies can prevent complications and improve overall health:
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Eat healthy. Be aware of portion sizes, and don’t skip meals.
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Be more active.
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Control high blood pressure and high blood sugar.
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Lose weight if needed. Extra weight can lead to high blood pressure and diabetes, which can hurt the kidneys.
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Avoid NSAIDs such as ibuprofen and naproxen, which can hurt the kidneys.
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Don’t take herbal supplements. Many herbal products can harm the kidneys.
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Don’t smoke. Smoking increases the chance of heart and lung disease and stroke.
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If you need a test, such as an MRI with contrast dye, make sure your doctor measures your kidney function first.
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Know your eGFR and UACR test results.
You might not even know you have hyperuricemia until gout or a kidney stone causes pain or other symptoms. Making some minor changes to your usual diet and exercise routine can lower your uric acid levels, prevent any future symptoms, and improve your overall health.
FAQ's
If gout isn’t treated, it can affect many joints and cause constant pain. It can also lead to lumps called tophi in other body parts.
Uric acid crystals might form kidney stones, which can:
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Block waste removal and cause infections.
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Damage the kidneys and possibly lead to kidney failure.
Visit our best nephrologists in Malleshwaram if you experience any new symptoms of hyperuricemia or chronic kidney disease (CKD), including swelling, discolouration or redness, a feeling of warmth or a joint that feels hot, trouble peeing, and pain while and after urination.
Depending on the diagnosis, you can ask the following questions:
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How high are my uric acid levels?
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Will I need treatment for hyperuricemia?
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What type of low-purine diet should I follow?
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Will I need any medication?
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