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Uric acid diathesis
Last reviewed: 12.07.2025
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Hyperuricosuria, hyperuricuria, urate or uric acid diathesis is defined as an innate predisposition of the body to increased excretion of the main end product of purine metabolism (protein metabolism) - uric acid. Excess of this acid leads to its crystallization and formation of salts that do not dissolve, but form concretions in the kidneys and bladder - uric acid (urate) stones.
Causes uric acid diathesis
Previously, uric acid diathesis was classified as an idiopathic condition and its pathogenesis was indirectly associated only with the predominance of animal protein foods containing purines in the diet. As a result of the biochemical transformation of purine bases in the human body, an average of 0.75-0.8 g of purine-2,6,8-trione - uric acid, which is excreted in the urine, is released per day.
Today, clinical urology sees the causes of uric acid diathesis in endogenous overproduction of uric acid, that is, in nitrogen metabolism disorders. According to statistics, uric acid diathesis in adults has this etiology in almost every third case.
It has been established that the predisposition to protein metabolism anomalies is genetic and inherited. Often this takes the form of xanthinuria, that is, a deficiency of the enzyme xanthine oxidase, which is involved in the formation of uric acid from xanthine and hypoxanthine.
In addition to the excessive concentration of uric acid, the level of urine acidity plays a key role in the pathogenesis of uric acid diathesis, since at a pH below 5.5, almost 100% of uric acid exists in an undissociated form. This means that uric acid does not dissolve in acidic urine and forms crystals. And researchers see the mechanism of urate crystal formation in the combination of several main factors: high urine acidity, hyperurinuria, low urine volume and a lack of extracellular fluid in the body. Thus, one or more of these factors are found in patients with uric acid stones (uric acid nephrolithiasis). Patients with gouty symptoms of uric acid diathesis usually have urine pH <5.5 and elevated levels of uric acid in the blood serum, and in urine it can be close to normal.
Causes of uric acid diathesis may also be related to other metabolic processes in the body. Recent studies have found a link with insulin resistance in patients with normal uric acid levels and urine acidity. Thus, many patients with idiopathic uric acid stones may have problems with insulin sensitivity ( diabetes insipidus ), which leads to increased urine concentration, insufficient urine volume, and increased uric acid and ammonium levels.
In addition to excess protein food, obesity, excessive vitamin intake (especially B3) and fluid loss due to vomiting in the first months of gestation, one of the causes of uric acid diathesis during pregnancy is excessive activity of the hypothalamic antidiuretic hormone vasopressin, which regulates the process of fluid excretion by the kidneys. Pregnant women also experience increased production of the hormone aldosterone by the adrenal glands, which increases the volume of circulating blood (which is necessary for bearing a child), but at the same time, the excretion of potassium from the body increases, which leads to an increase in the level of urine acidity, edema and increased blood pressure.
Uric acid diathesis in children may be associated with damage to the hypothalamus (which produces vasopressin ), which leads to many problems, including impaired glomerular filtration of the kidneys and increased uric acid levels. Uric acid diathesis in newborns is possible due to a rare congenital syndrome Lesch-Nyhan syndrome, in which male infants have an X-chromosomal deficiency of the enzyme phosphoribosyl transferase, which ensures the most important reaction of the purine cycle - the reutilization of purines. If this enzyme is lacking, the synthesis of endogenous purines increases sharply and turns the child into a disabled child.
[ Symptoms uric acid diathesis
Urologists believe that the first signs of uric acid diathesis are manifested in increased formation of uric acid crystals in urine. Although this requires that the acidity of urine be higher than the physiological norm of pH 6.5-7.
Urine is acidic by nature, but as long as the acidity level is low enough, a person does not experience any discomfort. When urine acidity increases (the pH value decreases), uric acid diathesis in adults can manifest itself as a burning sensation during urination: this is how the mucous membrane of the bladder and urethra reacts to the abnormal pH of urine. In addition, the color of overacidified urine is darker, and the smell is sharper.
Symptoms of uric acid diathesis with high blood acidity may also include fatigue, constipation, weight loss or gain, high blood pressure, heart problems, muscle weakness, and chronic kidney disease. High levels of uric acid in the blood (with insufficient filtration by the kidneys) can lead to gout attacks. However, it should be borne in mind that not everyone who has hyperuricosuria develops gout, and not everyone with gout has high uric acid levels (gout and uric acid diathesis are not the same thing).
Uric acid diathesis in children is manifested by the fact that when passing a urine test, the presence of uric acid crystals or salts is determined in it, as well as increased acidity of urine. Very high levels of uric acid are also observed in blood plasma. By the way, this may indicate that the child has problems with the thyroid gland - hypothyroidism.
Pediatricians highlight such key symptoms of uric acid diathesis as breath with the smell of acetone; causeless irritability; nausea and vomiting; poor appetite and weight loss, as well as pain - headaches, joints and kidneys.
Complications and consequences
The consequences of uric acid diathesis are the formation of urate (uric) stones. In 90% of cases, calcium or sodium salts are found in the composition of stones, in 15-20% of patients, calcium stones are formed in the kidneys; approximately the same picture is in people with gout. As a complication of urate diathesis, specialists name the chronic form of urolithiasis and renal failure. Severe hyperuricosuria can also lead to acute nephropathy: urates settle in the renal tubules with their subsequent obstruction and severe azotemia.
Diagnostics uric acid diathesis
Diagnosis of uric acid diathesis is carried out by a urologist or nephrologist, who prescribes the following tests:
- biochemical blood test to determine uric acid levels;
- blood test for hydrogen index (pH);
- general urine analysis;
- daily urine analysis (to determine diuresis, pH, uric acid, calcium, sodium, citrate, phosphorus, xanthine and creatinine).
Instrumental diagnostics of uric acid diathesis is an ultrasound of the kidneys, bladder and urinary tract, which can detect urate sand in them.
Problems with the violation of the general acid-base balance of the body (metabolic acidosis) revealed during the examination should be resolved by differential diagnostics - by examining the lungs and liver, as well as additional tests, for example, an analysis of arterial blood for carbon dioxide tension, for buffer bases and standard bicarbonates; a blood test for corticosteroids ( aldosterone ), etc.
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Treatment uric acid diathesis
The generally accepted treatment for uric acid diathesis is to prescribe a diet with limited protein, high fluid intake (up to two liters per day) and reduced salt (i.e. sodium). Low sodium intake reduces its excretion from the body, reduces the formation of monosodium urates, and also helps reduce the excretion of calcium in the urine.
The recommended diet for uric acid diathesis is No. 6, for more details see – diet for elevated uric acid.
The most important drugs used to reduce uric acid in urine are those that alkalize urine to a pH of 6.5-7. These include Potassium Citrate (Urocit, Kalinor, Policitra-K), which inhibits calcium oxalate crystallization and reduces urine acidity. As well as Soluran tablets (Blemaren), which contain a mixture of potassium citrate and citrate, which make urine more alkaline.
The drug Allopurinol (Zyloprim) inhibits the enzyme xanthine oxidase and thereby reduces the conversion of hypoxanthine and xanthine into uric acid. The initial dosage is 300 mg per day.
Traditional treatment is carried out with the help of diuretic decoctions and infusions, that is, this is traditional herbal treatment. For their preparation, such medicinal plants as bearberry, bird's knotweed (knotweed), hernia, field horsetail, elecampane, couch grass (rhizomes), birch buds, lingonberry leaf, rose hips, etc. are used. Decoctions are prepared in a standard way: a tablespoon of dry raw materials is poured with 250-300 ml of boiling water, brought to a boil and left for 40-45 minutes to infuse. The entire infusion is taken for 100 ml at a time. It should be borne in mind that diuretics are prescribed to children and pregnant women with caution - only after passing a daily urine test.
In the arsenal of drugs that homeopathy provides, experts note Causticum, Kalium carbonicum, Lycopodium.
Forecast
With proper nutrition and careful attention to your health, the prognosis is positive. And remember: uric acid diathesis should not develop into kidney failure, and only medicine can help you with this.