Reasons for the formation of uric acid crystals in urine

Metabolic processes occur in the body continuously. Some compounds are formed, others are cleaved and excreted in different ways. The main route of elimination is renal filtration, which produces urine. Together with it, most of the waste and waste products of the body are excreted. An example of such a substance is uric acid in urine, which characterizes the state of protein metabolism.

How is uric acid formed in the human body?

Uric acid is one of the end products of catabolism (breakdown) of purine bases. Purines form the basis of nucleoproteins – special proteins that are found in the DNA and RNA of every cell. In addition to synthesis by the body, purines are also found in food. A person produces from 12 to 30 g of uric acid per day. If its level in the blood increases (hyperuricemia), then it also rises in the urine. This condition is called uricosuria. If the pH of the urine is acidic, that is, less than 5, sodium and potassium salts of uric acid – urate crystals – precipitate. They can be detected using a routine urinalysis.

The norm of the substance during laboratory examination

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A general urine analysis with sediment microscopy can determine the presence of an excess of urate. For its delivery, it is necessary to conduct a thorough toilet of the external genital organs in the morning, then collect the first morning urine in a clean, dry container. Try to take a medium portion of urine, as it is the most informative for the laboratory assistant. Deliver the material to the laboratory within 2 hours. It is considered the norm if crystals of uric acid are not detected or their small amount is determined – from “+” to “++”.

If the general analysis revealed uraturia, it can be recommended to repeat it some time after the correction of the diet. After all, it is quite possible that a person the day before simply consumed a lot of foods rich in purine bases. This condition does not require special treatment, except for the normalization of the diet. If the analysis again shows an excessive amount of urate, it is necessary to refer the patient to determine the daily level of uric acid in the urine.

The method of collecting daily urine for analysis for uricosuria:

  • In the morning at 6.00 the patient urinates in the toilet.
  • Hygiene procedures are performed – washing of the external genital organs.
  • All subsequent urinations are carried out in a clean container with a volume of about 3 liters, which is kept cold.
  • The next day, morning urination is made into a container, and the collection is considered complete.
  • The urine collected in 24 hours is stirred, and a portion of about 50-100 ml is taken from it, which is sent to the laboratory for research.
  • When collecting urine, do not take acetylsalicylic acid, uroantiseptics, corticosteroids, diuretics, drugs to lower the level of uric acid.
  • Analysis in women is not performed during menstruation.
  • the norm for infants (up to 1 year old) is 0,35-2 mmol/l,
  • children 1-4 years old – up to 2,5 mmol/l,
  • children 5-8 years old 0,6-3 mmol/l,
  • children aged 9 to 14 years – 1,2-6 mmol/l,
  • adolescents 15-18 years old – 1,48-4.43 mmol/l,
  • standard values ​​for women are 150-350 μmol/l,
  • in men – 210-420 mmol/l.

Both an increase and a decrease in the excretion of uric acid in the urine may indicate the presence of a disease. For a more complete understanding of the reasons, it is necessary to determine the level of a substance in the blood.

When does uricosuria occur?

You should not immediately panic when you detect increased uric acid. It is necessary to understand the temporary causes of uricosuria, and only, having excluded them, think about possible diseases.

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In addition to pathological conditions, the cause of uricosuria most often lies in the patient’s diet. This is facilitated by the use of high-protein foods that contain many purine compounds. These include:

  • meat, especially young animals,
  • offal (kidney, liver, brain),
  • tomatoes,
  • beans,
  • fish, especially canned fish,
  • greens, especially spinach,
  • mushrooms,
  • seafood,
  • smoked products, marinades,
  • pickles,
  • chocolate, cocoa,
  • coffee and black tea,
  • alcohol.

Important! Purine-rich foods promote acidification of urine, in which uric acid crystals are deposited. If such a diet forms the basis of a person’s lifestyle, this will sooner or later lead to the development of urolithiasis.

Physiological factors

In addition to diet, there are a number of physiological prerequisites for uricosuria:

  • male,
  • negroid race,
  • hyperhidrosis (increased sweating),
  • starvation,
  • regular strong physical activity.

Such uricosuria disappears after lifestyle correction.

Medication administration

The increased excretion of urate in the urine can lead to the intake of certain drugs:

  • cytostatics,
  • beta blockers,
  • thiazide diuretics,
  • Theophylline,
  • some antibiotics.

If the patient is taking any medications, and his uric acid concentration is increased, you need to tell the doctor about it. Perhaps he will recommend canceling the appointment and retaking the test for the level of uric acid.

Diseases that lead to uricosuria

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Pathological reasons for an increase in uric acid are as follows:

  • Pathology leading to dehydration of the body contributes to the concentration of urine and, accordingly, the occurrence of uricosuria. This is prolonged diarrhea, persistent vomiting, febrile temperature, as symptoms of infectious diseases, gestosis in the second half of pregnancy.
  • Violation of renal blood flow due to anomalies in the development of blood vessels, their atherosclerosis, thrombosis, embolism, bending of the arteries with nephroptosis.
  • Gout is an metabolic disorder characterized by persistent hyperuricemia, uricosuria, as well as damage to the joints, kidneys, soft tissues, where urates are deposited, causing inflammation.
  • Urolithiasis and dysmetabolic urate nephropathy.
  • Inflammatory kidney disease such as glomerulonephritis. Urinary tract infections (pyelonephritis, cystitis), symptoms of which are fever, chills, frequent and painful urination, vomiting, discoloration and odor of urine.
  • Renal failure (end stage), when the kidneys become unable to maintain the pH of the urine at a normal level. Acidification of urine leads to the precipitation of urate crystals.
  • Diabetes.
  • Leukemia.
  • Malignant neoplasms of different localizations.
  • Chronic purulent diseases: abscess, osteomyelitis.
  • Viral hepatitis.
  • Down syndrome.
  • Cystinosis.
  • Lesch-Nihan syndrome.
  • Sickle cell anemia.

The list of diseases is quite large, therefore, if an increased level of uric acid in the urine is detected, you should immediately consult a doctor to determine the cause.

Uricosuria in children

In pediatrics, there is the concept of uric acid or neuro-arthritic diathesis – this is an anomaly of the constitution, which is characterized by the tendency of the child’s body to metabolic disorders: the formation of uric acid in excess of the norm, ketoacidosis, nutritional disorders. Such children, as a rule, are thin, nervous, capricious. In adulthood, they are prone to the development of gout, urolithiasis. Despite the fact that they are physically weaker than their peers, in mental development they are often much stronger. When the diet is disturbed, episodes of vomiting often occur as a result of an increase in ketone bodies in the blood. By adolescence, in most children, the phenomena of uric acid diathesis disappear on their own.

When does uraturia decrease occur?

Both an increase and a decrease in the level of uric acid may indicate pathology. Conditions leading to decreased urinary urate excretion:

  • dietary restrictions (food low in purine bases),
  • hyperparathyroidism
  • hypothyroidism,
  • chronic glomerulonephritis,
  • xanthinuria,
  • alcoholism,
  • taking medications: Quinine, Pyrazinamide, large doses of salicylates, Potassium iodide, Allopurinol, Atropine, iodine-containing contrast agents.

Uricosuria treatment

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How to get rid of uric acid, if its level in urine exceeds the permissible norm, a qualified specialist will tell you: a family doctor, therapist, urologist, nephrologist. First of all, one should start by normalizing the diet and eliminating foods that contain large amounts of purines. It is necessary to sharply limit the consumption of meat and offal, legumes, pickles, canned, pickled foods, chocolate, alcohol.

It is recommended to enrich the diet with low-fat dairy and sour-milk products, vegetables and fruits, juices, and dried fruits. It is allowed to eat poultry, honey. In no case should starvation be allowed. The daily calorie content is about 2500 kcal in the absence of obesity.

It is necessary to drink a sufficient amount of liquid – not less than 2 l/day. It is useful to drink alkaline mineral water without gas. This will prevent the development of concentration of urine and the loss of urate crystals.

In addition to diet, you need to reconsider your lifestyle. To date, a link has been proven between elevated uric acid levels and metabolic syndrome. This syndrome is also called the “death quartet”. It includes arterial hypertension, diabetes mellitus, increased cholesterol and obesity. Metabolic syndrome is the cause of death of millions of people around the world, and is rightfully considered the “disease of civilization.” Therefore, it is important to lose weight by increasing physical activity, lowering blood pressure, and normalizing blood sugar and cholesterol levels through diet.

If the cause of uricosuria is a disease, it is treated. Medical therapy is prescribed by a doctor. Before urinary tract stones form, the following drugs may be effective:

  • Blemaren – helps to increase urine pH and dissolve urate crystals.
  • Benzobromarone increases the excretion of uric acid in the urine, decreasing its level in the blood.
  • Allopurinol lowers the level of uric acid in the blood and breaks down its deposits in the tissues.
  • Urolesan, Kanefron help to improve the outflow of urine.
  • Panangin or Asparkam – contain potassium, help with urate and oxalate deposits.
  • Herbal diuretics, such as the herb, are half gone.

In the presence of urate stones, minimally invasive techniques of distant radio wave, laser, ultrasound or contact lithotripsy (crushing) are used. With large stones, surgical removal is performed.

Thus, the excess excretion of uric acid in the urine is caused by both various diseases and an unhealthy lifestyle. But, whatever the reason, you should never self-medicate. Better to entrust your health to a qualified doctor.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.