Uric Acid

At a Glance

Why Get Tested?

To detect high levels of uric acid in the blood, which could be a sign of the condition gout, or to monitor uric acid levels when undergoing chemotherapy or radiation treatment; to detect high levels of uric acid in the urine in order to diagnose the cause of kidney stones and to monitor those with gout who are at risk of developing such stones

When To Get Tested?

When you have joint pain or other symptoms that your healthcare practitioner suspects may be due to gout; when you have had or are going to have certain chemotherapy or radiation therapies for cancer; when you have recurrent kidney stones; when you have gout or are otherwise at risk for kidney stone formation

Sample Required?

A blood sample drawn from a vein in the arm or a 24-hour urine sample

Test Preparation Needed?

None may be needed; however, some institutions recommend fasting. Follow any instructions you are given.

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Looking For Reference Ranges?

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Uric acid is produced by the breakdown of purines. Purines are nitrogen-containing compounds found in the cells of the body, including our DNA. This test measures the level of uric acid in the blood or urine.

As cells get old and die, they break down, releasing purines into the blood. To a lesser extent, purines may come from the digestion of certain foods, such as liver, anchovies, mackerel, dried beans and peas and certain alcoholic drinks, primarily beer. Most uric acid is removed from the body by the kidneys and is eliminated from the body in the urine, with the remainder eliminated in the stool.

If too much uric acid is produced or not enough is removed, it can accumulate in the body, causing increased levels in the blood (hyperuricemia). The presence of excess uric acid can cause gout, a condition characterized by inflammation of the joints due to the formation of uric acid crystals in the joint (synovial) fluid. Excess uric acid can also be deposited in tissues such as the kidney, leading to kidney stones or kidney failure.

The build-up of too much uric acid in the body can be due to producing too much, not eliminating enough, or a combination of both. Elevated levels of uric acid can occur when there is an increase in cell death, as seen with some cancer therapies or, rarely, as an inherited tendency to produce too much uric acid. Decreased elimination of uric acid is often a result of impaired kidney function due to kidney disease.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm. A 24-hour urine sample may be collected for the urine uric acid test.

Is any test preparation needed to ensure the quality of the sample?

No test preparation may be needed. Some institutions, however, recommend fasting for 4 or more hours. Follow any instructions provided and be sure to discuss with your healthcare practitioner any medications you take before having this test performed.

Common Questions

How is it used?

The uric acid blood test is used to detect high levels of this compound in the blood in order to help diagnose gout. The test is also used to monitor uric acid levels in people undergoing chemotherapy or radiation treatment for cancer. Rapid cell turnover from such treatment can result in an increased uric acid level.

The uric acid urine test is used to help diagnose the cause of recurrent kidney stones and to monitor people with gout for stone formation.

When is it ordered?

The uric acid blood test is ordered when a healthcare practitioner suspects that someone has a high uric acid level. Some people with high levels of uric acid have a disease called gout, which is a common form of arthritis. People with gout suffer from joint pain, most often in their toes, but in other joints as well. The test is also ordered when cancer patients undergoing chemotherapy or radiation therapy to ensure that uric acid levels do not get dangerously high.

The urine uric acid test may be ordered when a person suffers from recurrent kidney stones or has gout and needs to be monitored for formation of these stones.

What does the test result mean?

Blood
Higher than normal uric acid levels in the blood is called hyperuricemia and can be caused by producing too much uric acid in the body or the inability of the kidneys to adequately remove enough uric acid from the body. Further investigation is needed to determine the cause of the overproduction or decreased elimination of uric acid.

There are several genetic inborn errors that affect the break-down of purines. Cancer that has spread from its original location (metastatic), multiple myeloma, leukemias, and cancer chemotherapy can cause increased production of uric acid. Chronic renal disease, acidosis, toxemia of pregnancy, and alcoholism can cause decreased elimination of uric acid.

Increased concentrations of uric acid can cause crystals to form in the joints, which can lead to the joint inflammation and pain characteristic of gout. Uric acid can also form crystals or kidney stones that can damage the kidneys.

The American College of Rheumatology published guidelines on the management of gout in 2012 that recommend that target serum urate (uric acid) levels should be below 6 mg/dL for people diagnosed with the condition.

Low levels of uric acid in the blood are seen much less commonly than high levels and are seldom considered cause for concern. Although low values can be associated with some kinds of liver or kidney diseases, Fanconi syndrome, exposure to toxic compounds, and rarely as the result of an inherited metabolic defect (e.g., Wilson disease), these conditions are typically identified by other tests and symptoms and not by an isolated low uric acid result.

Urine
High uric acid levels in the urine are seen with gout, multiple myeloma, metastatic cancer, leukemia, and a diet high in purines. Those at risk of kidney stones who have high uric acid levels in their urine may be given medication to prevent stone formation.

Low urine uric acid levels may be seen with kidney disease, chronic alcohol use, and lead poisoning.

Is there anything else I should know?

Many drugs can increase or decrease the level of uric acid. In particular, diuretic drugs like thiazide drugs can cause uric acid levels to go up.

Aspirin and other salicylates have varying effects on uric acid. At low aspirin levels (as may occur in persons taking aspirin only occasionally), aspirin can increase blood uric acid. On the other hand, in high doses (as may be used to treat rheumatoid arthritis), aspirin actually lowers the concentration of uric acid.

For people who have uric acid kidney stones or gout, foods that are high in purine content should be avoided, including organ meats (like liver and kidneys), sardines and anchovies. Alcohol also should be avoided because it slows down the removal of uric acid from the body. Fasting, rapid weight loss, stress, and strenuous exercise all raise uric acid levels.

Although the uric acid test cannot definitively diagnose gout, a test for monosodium urate in synovial fluid (joint fluid) can.

Some people may have a high level of uric acid in the blood without having associated signs or symptoms (asymptomatic hyperuricemia). However, general screening to detect this condition is not recommended, nor is treatment considered appropriate.

My uric acid level is high, but I don't have gout. What does this mean?

Not everyone who has high uric acid gets gout. High levels of uric acid in the blood do not always lead to symptoms. This condition, called asymptomatic hyperuricemia, is fairly common. It is generally thought that this condition does not require any follow up or treatment unless the affected person is at a high risk of complications. People with family members who have had gout, kidney stones or kidney disease due to hyperuricemia may receive treatment even though they are not experiencing symptoms.

View Sources

Sources Used in Current Review

2017 review performed by Brooke M Whitaker, MS, MLS(ASCP).

(2014). Diagnosing Gout. Gout & Uric Acid Education Society. Available online at http://gouteducation.org/medical-professionals/diagnosing-gout/. Accessed 4/30/17.

Khanna, D et. al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Non-pharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care & Research, Vol. 64, No. 10, October 2012, pp 1431–1446. DOI 10.1002/acr.21772. Available online at http://www.rheumatology.org/Portals/0/Files/ACR%20Guidelines%20for%20Management%20of%20Gout_Part%201.pdf. Accessed on 4/30/17.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, Harrison’s Principles of Internal Medicine, 19e Edition, McGraw Hill, New York, NY. Chapter 395 and 431. Accessed through Access Medicine 4/30/17.

Sources Used in Previous Reviews

Laboratory Tests & Diagnostic Procedures with Nursing Diagnoses (4th edition), Corbett, JV. Stamford, Conn.: Appleton & Lang, 1996. Pp. 105-109.

A Manual of Laboratory & Diagnostic Tests (sixth edition), Frances Fischbach, editor. Philadelphia: Lippincott Williams& Wilkins, 2000; Pp. 396-397.

Nader Rifai, PhD. Department of Laboratory Medicine, Children’s Hospital, Boston, MA.

NIAMS. Fast Facts about Gout. (Revised March 2007). Available online at http://www.niams.nih.gov/Health_Info/Gout/gout_ff.asp. Accessed June 2010.

MedlinePlus Medical Encyclopedia. Uric acid – blood. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003476.htm. Accessed June 2010.

MedlinePlus Medical Encyclopedia. Uric acid- – urine. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003616.htm. Accessed June 2010.

Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006, Pg 530.

Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. 4th edition, St. Louis: Mosby Elsevier; 2010 Pp. 536, 998.

MayoClinic.com. High uric acid level. (Last updated September 13, 2008). Available online at http://www.mayoclinic.com/health/high-uric-acid-level/MY00160. Accessed June 25, 2010.

The Gout and Uric Acid Education Society. Uric Acid. Available online at http://gouteducation.org/patient/about-gout/uric-acid/. Accessed June 25, 2010.

Mosby’s Diagnostic and Laboratory Test Reference, 3rd Edition. Pagana and Pagana. 1997. Pp. 842-845.

(August 2002) Dincer H, Dincer A, Levinson D. Asymptomatic hyperuricemia: To treat or not to treat. Cleveland Clinic Journal of Medicine, vol. 69, no. 8, Pp 594-608. Available online at http://www.ccjm.org/content/69/8/594.full.pdf+html. Accessed October 2010.

American College of Rheumatology. 2012 American College of Rheumatology Guidelines for Management of Gout. Available online at http://www.rheumatology.org/practice/clinical/guidelines/gout.asp. Accessed November 2012.

Walsh, N. ACR Puts Out Gout Guidelines. MedPage Today. Available online at http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/35033. Accessed November 2012.

KidsHealth. Blood Test: Uric Acid. Available online at http://kidshealth.org/parent/system/medical/test_uric.html. Accessed June 2013.

MayClinic.com. High uric acid level: Causes. Available online at http://www.mayoclinic.com/health/high-uric-acid-level/MY00160/DSECTION=causes. Accessed June 2013.

MedlinePlus Medical Encyclopedia. Uric acid – blood. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003476.htm. Accessed June 2013.

MedlinePlus Medical Encyclopedia. Uric acid – urine. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003616.htm. Accessed June 2013.

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