ABC OF : ASYMPTOMATIC HYPERURICEMIA. MAY BE USEFUL. ASYMPTOMATIC HYPERURICEMIA is a term traditionally applied to settings in which the SERUM URATE concentration is ELEVATED BUT in which NEITHER SYMPTOMS NOT 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....... 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....... 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.......



Dr.Raj Thorat Sir. U r absolutely correct. The supersaturated level of UA is for treating symptomatic gout. That , This guideline is for gout only is evidenced by pressing the link which unmistakely states the guideline. Certainly the guidelines do not warrent treatment of gout but do not talk of CAD risk which r benefited by treatment at levels well below normal UA . Hence the ecommendation for gout is , in way an objection in case of risk factor for CAD, and there is NO controversy in this regard. The difference is simple. At supersaturated levels only gout is called into play where as even lower levels risk the heart.!

Thank you Sir

Very useful talk about asymptomatic hyperuricemia in context to cardiovascular renal and locomotor should be in our routine clinical practise to measure serum uricacid level so that underlying cause in above cited disease is sorted out.and pt may be benifited.thanks.

Hyperuricemia is now one of the risk factor for CV events like ACS etc. Good information shared by you here.

As Dr Gaurav said that Hyperuricemia is one of the risk factors for CAD,in practice pts having asymptomatic Hyperuricemia (UA >7) but associated HTN/DM/IHD ,I prefer starting UA lowering drugs targeting UA less than 5 @Dr. Asv Prasad your opinion Sir

Useful and informative

Informative post.

Very informative and helpful post sir.

Indeed Informative...Thanks..@Dr. Puranjoy Saha

Nice information


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