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Article published in The Townsend Letter, June 2021 The views expressed in this article are not The Townsend Letter’s, they are those of the author. This article is not intended to be viewed as medical advice. Please check with your health care provider before starting to take any herbal supplements. A high level of uric acid is an often-unrecognized contributor to many disease states. While the uremic wastes creatinine and BUN are measured on a basic metabolic panel, a blood test for serum uric acid (urate) is usually not run unless the patient complains of gout symptoms. Gout is the most well-known consequence of high uric acid, but only one of many conditions impacted by uric acid. There may be a classical presentation of gout in the big toe or tophi with uric acid crystals forming nodules in various places. Gout may occur in the context of kidney weakness but is also seen in patients with normal creatinine and BUN. If other renal indicators are normal, diet and lifestyle factors are to blame. Conversely low uric acid can also be problematic. Depending on the conditions, uric acid can be both pro-inflammatory and anti-inflammatory. Too much or too little uric acid can be detrimental depending on the patient’s health status. Processing of Uric Acid Uric acid is produced in the liver cells by the major catabolic pathway of purine degradation. Uric acid is not metabolized in the liver but is excreted by the kidneys and intestinal tract. The enzyme directly responsible for the formation of uric acid is xanthine oxidase (XO), and many medications for uric acid target this enzyme. Other published approaches to lowering production of uric acid include the inhibition of purine nucleoside phosphorylase (PNP), just upstream from XO.1 Hyperuricemia induces the expression of hepatic inflammatory molecules by activating the pro-inflammatory NF-kB signaling cascade. It is also associated with higher levels of hsCRP, fibrinogen, complement C3, ferritin, and ESR. However, uric acid can also act as an antioxidant and free radical scavenger depending on the microenvironment.1 The pro-oxidant effects of uric acid mostly relate to its copper reducing, as Cu(+) can initiate lipid peroxidation. Uric acid also increases alpha-tocopherol consumption. The presence of nitric oxide, however, completely inhibited the pro-oxidant activity of uric acid.2 Demographics A variety of factors can make one more susceptible to hyperuricemia. Alcohol consumption Obesity Binge eating Genetics3 Chronic kidney disease Heavy meat diet Dehydration Advanced age4 African Americans5 Hyperparathyroidism (even in the absence of renal disease)6 Tumor lysis syndrome seen in cancer and chemotherapy, as there is a rapid release of the cell’s contents.7 Lab Tests Serum uric acid is the most direct way to check the patient’s status. In human blood plasma, the reference range of uric acid is from 3.6 to 8.3 mg/dL. There may be a more acidic urinary pH as the kidneys are passing uric acid or a higher urinary pH if the uric acid is crystalizing into stones.7 Uric Acid and Kidney Health It is often hard to separate cause and effect. High uric acid can result from kidney weakness, but uric acid itself can contribute to kidney damage. Hypertension: Uric acid increases salt sensitivity and xanthine oxidase-related oxidative stress causes endothelial dysfunction and renal vasoconstriction.8 Nephrotic syndrome: Increased xanthine oxidase activity and uric acid are associated with an increase in the pro-inflammatory compounds toll like receptor 4 (TLR4) and fibronectin. Expression of these compounds is part of a maladaptive immune response associated with proteinuria. Use of allopurinol was seen to reduce proteinuria.9 Loss of filtration: High uric acid can be a causative factor in the progression of chronic kidney disease, altering tubular epithelial cells, endothelial cells, and vascular smooth muscle cells, leading to a pro-inflammatory, profibrotic state.10 Uric acid kidney stones: After oxalate stones, uric acid stones are the second most prevalent type. Some kidney stones are mixed in composition. As oxalates are only found in plants and uric acid is associated with a heavy meat intake, knowing the patient’s eating habits is helpful in determining a course of action.
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शरीरमा प्रोटिनको मेटाबोलिज्म भएर निस्कने तत्वलाई युरिक एसिड भनिन्छ । न्युक्लिक एसिड र प्युरिन ग्रुपको प्रोटिनबाट मात्र युरिक एसिड बन्छ । यो सामन्यतय पिसाबबाट बाहिर निस्कन्छ । जब मृगौलाको छान्ने क्षमता कम हुन्छ र युरिक एसिड रहन्छ, तब त्यो हड्डीको जोर्नीमा गएर जम्मा हुन्छ । मृगौलाले युरिक एसिड कम उत्सर्जन गर्दा पनि त्यो रगतमा जम्मा हुन पुग्छ । उपवास वा तिव्र रुपमा तौल घटाउने चक्करमा पनि अस्थायी रुपले युरिक एसिडको स्तर बढ्न सक्छ । साथै, युरिक एसिड बढाउनमा मधुमेहको औषधी पनि एउटा कारण बन्न सक्छ । सुरुसुरुमा यूरिक एसिड बढ्नुको कुनै लक्षण देखिदैन । कयौ मानिसलाई त यसको लक्षण र यसलाई पहिचान गर्ने तरीका पनि थाहा हुँदैन । सामान्यतया, यूरिक एसिड बढेमा जोर्नी दुख्ने, उठ्न–बस्न कठिनाई हुने, औला सुन्निने, जोर्नीमा गाँठो पर्ने गर्छ । त्यस्तै, हात तथा खुट्टा घोचाई सहितको तिव्र पिडा हुने गर्छ । यूरिक एसिड भएमा मान्छे चाँडै थकित हुन्छ । त्यसबाहेक, मिर्गाैलाको समस्या तथा पिसाब फेर्नमा कठिनाई हुने गर्छ । यूरिक एसिड बढ्नुको कारण -खानपान तथा जीवनशैलीको बदलाव नै यूरिक एसिड बढ्नुको मुख्य कारण हो । -मधुमेह रोगीले सेवन गर्ने औषधीका कारण पनि यूरिक एसिड बढ्नसक्छ । -रातो मासु, सी फूड, दाल, राजमा मसरुम, टमाटर, बन्दा, मटर, पनीर, भिण्डी, चामल लगायतका कारण पनि शरीरमा यूरिक एसिड बढ्ने गर्छ । -खानाको रुपमा सेवन गरिने प्रोटिनले पनि शरीरमा यूरिक एसिडको मात्रा बढाउने गर्छ । -जर्बजस्तीको एक्सरसाइज तथा तौल कम गर्ने चक्करमा पनि यूरिक एसिडको समस्या निम्तिने गर्छ । -उच्च रक्तचापमा सेवन गरिने औषधी, पेन किलर तथा क्यान्सरको उपचारमा प्रयोग हुने औषधीले पनि यूरिक एसिडको मात्रा बढ्ने गर्छ । -यस्तै, आणुवंसिकता, शरीरमा आइरनको मात्रा बढेमा, थाइराइडको समस्या भएमा, मिर्गाैला खराब भएमा, मोटोपना भएमा वा अत्याधिक मात्रामा मदिरापानका कारण पनि यूरिक एसिड बढ्ने गर्छ । के हुन्छ असर ? शरीरको साना–साना जोर्नीमा दुख्ने समस्या निम्त्याउँछ । यदि तपाईको उमेर २५ बर्षभन्दा बढी भएको छ र धेरै खाना खानुहुन्छ भने तपाई यस रोगको जोखिममा पर्नुहुनेछ । राती सुतेको बेला हात औंला, खुट्टाको औंलाको जोर्नीमा दुखाई महसुष हुन्छ भने त्यो युरिक एसिडको लक्षण हुनसक्छ । युरिक एसिड खासगरी हड्डीको जोर्नीमा गएर जम्मा हुन्छ । यस रोगले शरीरको स–साना जोर्नीमा असर गर्छ । जोर्नीमा पीडा महसुष हुन्छ । कसरी नियन्त्रण गर्ने ? – पर्याप्त पानी वा झोलयुक्त खानेकुरा सेवन गर्ने, जसले बढी भन्दा बढी युरिक एसिड पिसाबको माध्यामबाट बाहिर निस्कन्छ । – खानपानमा सतर्कता अपनाउनु पर्छ । खासगरी प्रोटिनयुक्त खानेकुरा सेवन गर्नु हुँदैन । -रातो मासु, कलेजो, रक्सी, गेडागुडी जस्ता खानेकुराले युरिक एसिडको जोखिम बढाउँछ । -हरेक दिन खाने भोजनमा कम्तीमा ५ सय ग्राम भिटामिन–सि जरुर लिनुहोस् । – नियमित व्यायाम गर्नुपर्छ । स्वथ्य खानपान र जीवनशैली अपनाउनुपर्छ ।