LOW URIC ACID: causes and symptoms

The feedback from low uric acid it is rare and usually not of concern. The main causes of reduced uric acid are increased renal elimination, often due to concomitant drug therapy, or reduced urate production due to rare genetic disorders, particular drugs or a diet low in protein. In most cases there are no specific symptoms associated with hypouricemia.

Uric acid

What is Uric Acid? What does it mean uricemia? L'uric acid it is the final product of the degradation of purines, which are a fundamental component for the construction of our DNA. L'uricemia  it is nothing more than a term used to indicate the levels of uric acid in the blood. Uric acid is produced mainly in the liver in the small intestine, that is, in the two systems that contain an enzyme called xanthine oxidase, which is essential for the breakdown of purines and the production of urates. The uric acid thus produced is eliminated mainly by the kidney about three quarters of the total, while the residual amount is eliminated by the intestine.

Low uric acid

Uric acid metabolism and inhibitory action of allopurinol.

Low uric acid

The finding of a reduction in uric acid values is neither frequent nor usually worrying. The main reasons for the drop in uricemia levels (called hypouricemia) are above all the increased renal elimination, often due to concomitant drug therapy, and / or the reduced production of uric acids. But let's see when it comes to low uric acid.

Low uric acid levels

The concentration of uric acid in plasma varies with age and sex, but for the reference range, low uric acid values are practically the same for women and men, young or old. We talk about low uric acid when its levels are below 4 mg / dl (milligrams per deciliter) or 238 µmol / l (micromoles per liter) in men and below 2.5 mg / dl (milligrams per deciliter) ie 149 µmol / l (micromoles per liter) ) in women (source Healtline).

Causes of low uric acid

The main causes of low uric acid are essentially two

  • Reduced production of uric acids
  • Increased renal or intestinal elimination of urates

In reality, these two mechanisms often coexist. Hypouricemia is a rare finding, as it is thought to be present in less than 0.2% in blood tests performed by the general population, and less than 0.8% in blood tests performed by hospitalized patients.

In most cases, low uric acid is secondary to increased renal excretion. Often the culprit is a drug with uricosuric properties, that is, it accentuates the elimination of uric acid in the urine.

Below we report the medications that more frequently can give this problem:

  • Furosemide and other diuretic drugs
  • Ascorbic acid, or vitamin C
  • Citrate,
  • Dicumarols such as warfarin (coumadin),
  • iodized contrast medium used in radiology,
  • Estrogen hormones such as the pill,
  • Glucocorticoids (cortisone drugs),
  • Acetylsalicylic acid (aspirin) in doses greater than 2 g per day
  • Tetracyclines (a particular antibiotic drug) when used after the expiration date.

Total parenteral nutrition, i.e. intravenous nutrition, can also cause hypoglycaemia probably due to the high glycine content in the infusion bags.

Other diseases that can increase renal clearance of urates are:

  • cirrhosis of the liver
  • diabetes mellitus
  • inappropriate secretion of ADH (vasopressin) such as in SIADH
  • some types of neoplasms
  • a storage disease called cystinosis
  • multiple myeloma
  • heavy metal intoxication
  • congenital kidney problems with congenital defects of uric acid transport, such as renal tubule defects (Fanconi syndrome or Wilson disease)

There are also very rare hereditary causes which involves a reduced production of urates. All of these causes are characterized by the finding of normal or elevated uricosuria (concentration of uric acid in normal or elevated urine).

This data allows to differentiate the low uric acid picture from reduced production, which instead is characterized by a reduced or absent quantity of uric acid in the urine.

The main causes of reduced uric acid production are all diseases that involve a deficiency in purine production, and all those therapies that inhibit DNA production such as anticancer therapies (chemotherapies).

Furthermore, patients treated with allopurinol (trade name Zyloric) used to reduce blood levels of uric acid, may have a low uricaemiaa or deleted.

Finally, uricemia and diet they can also be connected in a negative sense: a low-protein diet can contribute, in part, to the reduction of urate values in the blood.

Low Uric Acid Symptoms

What are the main symptoms of hypouricemia? Uric acid: symptoms specific? Most cases of uric acids reduced is not associated with any type of particular symptom. The only symptoms that may be present are not directly related to low uric acid levels, but rather to the concomitant pathology that may be present, such as

  • Skin jaundice, weight loss, fatigue, fluid accumulation in case of liver cirrhosis
  • Tiredness, weight loss, skin pallor, widespread pain in case of neoplasms
  • Confusion, very high blood sugar, abundant and frequent urination in inadequately treated diabetes mellitus
  • Accumulation of fluids various parts of the body reduction of the amount of urine in the SIADH

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1 Comment
  1. Walter Villanova 4 years ago

    I believe it would be appropriate to raise awareness among the lay reader to indicate a tolerable low or high limit of the value under discussion. Let me explain: can a zero point two or point four be indicative and require further exams? This is my specific case, as a year ago the result indicated a value equal to 3.4. Repeated today this value is 3.0.
    Thanks.

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