- Michael A Becker, MD
Michael A Becker, MD
- Section Editor — Crystal Diseases
- Professor Emeritus of Medicine
- University of Chicago Pritzker School of Medicine
Asymptomatic hyperuricemia is a term traditionally applied to settings in which the serum urate concentration is elevated but in which neither symptoms nor signs of monosodium urate (MSU) crystal deposition disease, such as gout, or uric acid renal disease, have occurred. Although these clinical manifestations may develop in a hyperuricemic individual at any point, about two-thirds or more of such individuals remain asymptomatic, never developing gouty arthritis, tophaceous gout, acute or chronic hyperuricemic nephropathy, or uric acid nephrolithiasis [1-5]. (See "Clinical manifestations and diagnosis of gout" and "Uric acid renal diseases" and "Uric acid nephrolithiasis".)
In addition to its relationship with urate or uric acid crystal deposition, asymptomatic hyperuricemia has also been associated with other disorders that appear to be largely unrelated to crystal deposition, including hypertension, chronic kidney disease, cardiovascular disease, and the insulin resistance syndrome. (See "Overview of the possible risk factors for cardiovascular disease", section on 'Uric acid' and "Secondary factors and progression of chronic kidney disease", section on 'Hyperuricemia' and "The metabolic syndrome (insulin resistance syndrome or syndrome X)", section on 'Other associations'.)
The definition, etiology and management of asymptomatic hyperuricemia will be reviewed here. Gout, uric acid renal diseases, and uric acid nephrolithiasis are discussed separately. (See "Clinical manifestations and diagnosis of gout" and "Treatment of acute gout" and "Prevention of recurrent gout: Pharmacologic urate-lowering therapy and treatment of tophi" and "Uric acid renal diseases" and "Uric acid nephrolithiasis".)
There is no universally accepted definition of hyperuricemia. For purposes relating to urate crystal deposition, a physiochemical definition of hyperuricemia, based upon the solubility limit of urate in body fluids (ie, the concentration above which a state of supersaturation for urate is reached in the serum) is widely preferred over a statistical definition because of the non-normal distribution of serum urate concentrations in most populations [6-9]. This physicochemical definition corresponds to urate concentrations exceeding about 7 mg/dL (416 micromol/L), as measured by automated enzymatic (uricase) methods in routine clinical laboratory use. These values are approximately 1 mg/dL (60 micromol/L) lower than those obtained with colorimetric methods.
A definition of hyperuricemia appropriate to the non-crystal deposition associations with hyperuricemia (eg, cardiovascular disease) is more problematic for two reasons. One is the high prevalence of urate values exceeding saturation but within two standard deviations of the population mean (eg, an estimated 5 to 8 percent in adult white males in the US and 25 percent in Taiwan Chinese males) . The other is that associations of serum urate levels with cardiovascular and other disorders are detected at concentrations that are clearly subsaturating [11,12].
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- POTENTIAL CLINICAL CONSEQUENCES
- Urate crystal deposition disorders
- - Gout
- - Chronic kidney disease
- - Nephrolithiasis
- Non-crystal deposition disorders
- Initial evaluation
- Further evaluation
- General measures
- Sustained marked hyperuricemia
- Recurrent uric acid urolithiasis
- Marked asymptomatic hyperuricosuria
- Tumor lysis
- Hyperuricemia and conditions unassociated with crystal deposition
- SUMMARY AND RECOMMENDATIONS