Gout and Hyperuricemia

Gout is a painful disease that occurs when uric acid, a normal waste product, builds up in the blood and forms crystals in the joints and/or kidneys.

Uric acid normally dissolves in the blood, processes through the kidney, and leaves the body in the urine. If the body makes extra uric acid, or if the kidneys cannot clear enough of it, then uric acid levels in the blood will become too high, a condition known as hyperuricemia (hyper-yur-i-see-me-ya).

Hyperuricemia is not a disease and may not cause problems, but if it continues for a long time and conditions in the body are right, crystals may form and cause gout. Most experts recommend that uric acid levels stay below 6.0 mg/dL in order to prevent gout attacks.

Uric acid comes from the breakdown of purines, naturally-occurring chemicals that are found in both our diets and our bodies. Foods and drinks that contribute most to hyperuricemia and gout include: redmeat, organ meat, seafood, beer, liquor, and sugar-sweetened items, especially with high fructose corn syrup. Health problems such as obesity,high blood pressure, high blood sugar, and high cholesterol may also lead to increased uric acidand the development of gout. And because some medications may also increase risk, you should review all your medications and supplements with your doctor. Other causes of hyperuricemia and gout include kidney disease, exposure to lead, hypothyroidism, severe illness or stress, and extreme physical exertion.

Some people with gout do not have high uric acid levels, so it is very important to maintain a healthy lifestyle no matter the level. Do not smoke, follow a well-balanced diet, maintain a healthy weight, and exercise.

Joint and Kidney Damage Caused by Gout

Uric acid crystals deposited in the joints can cause pain, swelling, stiffness, and deformity, and impair movement.

Uric acid crystals deposited in the kidneys can become large stones. These stonesare very painful and can cause permanent kidney damage by 1) forming an obstruction that prevents your kidneys from removing wastes and causing infection, and 2) scarring the kidneys with rough or sharp edges. Both problems can lead to chronic kidney disease and even kidney failure.

Chronic kidney disease occurs when the kidneys have been damaged and/or kidney function has been greatly decreased for more than 3 months, andit is detected with routine laboratory tests. One of these tests is estimated glomerular filtration rate (eGFR) which determines the level of kidney function. Another test measures albumin in the urine and is called urine albumin-to--creatinine ratio (ACR). Albumin in the urine may be a sign of kidney damage.

Kidney failure occurs when kidney function is so poor that there are severe symptoms, or when there is a need for dialysis or transplant to treatcomplications that could lead to more sickness and death.

Prevent Gout Attacks and Kidney Damage

Focus on lifestyle changes to reduce your risk for developing gout and kidney damage. High uric acid is the strongest risk factor for developing gout, but if you eliminate the causes of high uric acid such as obesity and high blood pressure, then you may prevent gout attacks.

Follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low fat dairy products. Limit sugar-sweetened foods and drinks, especially those that contain high fructose corn syrup. Limit alcohol, meat, and fish, especially shrimp and lobster. Avoid crash diets because they can make the urine more acid, which makes it harder for uric acid to dissolve.

Drink at least 64 ounces of water a day (8 cups) to help reduce the risk for stone formation.

Follow the medication regimen prescribed by your doctor.

Track your serum uric acid (sUA) level (amount of uric acid in your blood), estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratiousing the online Gout and Uric Acid Tracker by clicking here (Excel download), or by printing out the PDF version. You can also record your weight, blood pressure, gout symptoms, and triggers for your attacks. By keeping track of this information, you will see how well you are preventing attacks. If you are having problems, the reasons will be clear, and you and your doctor can fine-tune your treatment plan.

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© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.