hiperurykemia

Hiperuricemia is a condition defined by elevated levels of uric acid in the blood. It results from an imbalance between uric acid production and its elimination, with a common biochemical threshold around 6.8 mg/dL (404 µmol/L) of serum. Not all individuals with hyperuricemia develop symptoms, but it can lead to gout, uric acid stones, or kidney problems in some people.

Causes of hyperuricemia are classically divided into overproduction and under-excretion. Under-excretion by the kidneys is the most frequent cause and can be influenced by kidney disease, certain medications (such as thiazide diuretics and low-dose aspirin), and metabolic factors. Overproduction can occur with increased purine turnover or genetic factors. Lifestyle factors—high-purine diets (red meat, seafood), excessive alcohol (especially beer), and high-fructose intake—also raise uric acid levels. Men are at higher risk, as are individuals with obesity or metabolic syndrome; postmenopausal women may also be affected.

Clinical features include acute arthritis due to monosodium urate crystal deposition (gout), chronic tophaceous gout in untreated cases, and uric acid nephrolithiasis. Asymptomatic hyperuricemia may be detected incidentally. Diagnosis relies on serum uric acid measurement and, during flares, synovial fluid analysis showing needle-shaped crystals; imaging can detect crystal deposits.

Management focuses on risk modification and symptom control. Lifestyle changes (weight management, reduced purine and alcohol intake, hydration) are important. Acute gout flares are treated with NSAIDs, colchicine, or corticosteroids. Urate-lowering therapy, such as xanthine oxidase inhibitors (allopurinol, febuxostat) or uricosurics (probenecid), is considered for persistent hyperuricemia to maintain target serum urate levels below 6 mg/dL (360 µmol/L) and reduce complications, with dose adjustments for kidney function and comorbidities.