Uric acid is produced when the body breaks down purines and can build up in the blood if too much is produced or not enough is removed by the kidneys. High levels of uric acid can cause gout or kidney stones. Gout causes sudden, painful inflammation in joints while kidney stones are painful mineral deposits that form in the kidneys from uric acid crystals. Fanconi syndrome is a rare kidney disease that causes low uric acid levels due to the kidneys' inability to absorb nutrients, leading to their loss in urine.

1. URIC ACID AND
RELATED
DISORDERS
Zar**Rish

2. URIC ACID
Uric acid is a chemical created when the body breaks
down substances called purines.
Purines are normally produced in the body and are also
found in some foods and drinks.
Foods with high content of purines include liver, anchovies,
mackerel, dried beans and peas, and beer.
uric acid dissolves in blood and travels to the kidneys. it
passes out in urine

3. URIC ACID
If your body produces too much uric acid or does not
remove enough of it, you can get sick.
Uric acid can build up in the blood
Uric acid levels can also increase when you eat too many
high-purine foods or take medicines like diuretics, aspirin,
and niacin
Then crystals of uric acid can form and collect in the joints.
This causes painful inflammation
This condition is called gout. It can also lead to kidney
stones.

4. REGULATION OF URIC ACID METABOLISM AND EXCRETION

5. REGULATION OF URIC ACID METABOLISM AND EXCRETION

6. REFERENCE RANGE

7. REFERENCE RANGE
The following table gives low, normal, and high levels of
uric acid in the blood. All amounts are in milligrams per
deciliter (mg/dl).
Uric acid level Males Females
Low Below 2.5 mg/dl Below 1.5 mg/dl
Normal 2.5–7.0 mg/dl 1.5–6.0 mg/dl
High Above 7.0 mg/dl Above 6.0 mg/dl

8. HYPERURICEMIA (HIGH URIC ACID)
Hyperuricemia is an excess of uric acid in the blood.
Uric acid passes through the liver, and enters into bloodstream
Most of it is excreted in urine, or passes through intestines to
regulate "normal" levels
Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0
mg/dL (male).
Increased levels of uric acid from excess purines may accumulate
in tissues, and form crystals. This may cause high uric acid levels in
the blood
Uric acid formation may occur when the blood uric acid level rises
above 7 mg/dL.

9. CAUSES OF HYPERURICEMIA )

10.  If your blood uric acid levels are significantly elevated, and you are
undergoing chemotherapy for leukemia or lymphoma, you may have
symptoms kidney problems, or gouty arthritis from high uric acid levels
in your blood.
 You may have fever, chills, fatigue if you have certain forms of cancer,
and your uric acid levels are elevated (caused by tumor lysis syndrome)
 You may notice an inflammation of a joint (called "gout"), if the uric acid
crystals deposit in one of your joints. (*Note- gout may occur with
normal uric acid levels, too).
 You may have kidney problems (caused by formation of kidney stones),
or problems with urination
SYMPTOMS OF HYPERURICEMIA:

11. •Non-steroidal anti-inflammatory (NSAID) agents and Tylenol®- such as naproxen sodium and
ibuprofen may provide relief of gout-related pain. Gout may be a result of a high uric acid level.
•If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are
receiving, acetaminophen (Tylenol) up to 4000 mg per day (two extra-strength tablets every 6
hours) may help.
•Uricosuric Drugs: These drugs work by blocking the reabsorption of urate, which can prevent
uric acid crystals from being deposited into your tissues. Examples of uricosuric drugs include
probenecid, and sulfinpyrazone.
•Xanthine oxidase inhibitors - Such as allopurinol, will prevent gout. However, it may cause your
symptoms of gout to be worse if it is taken during an episode of painful joint inflammation.
•Allopurinol may also be given to you, if you have a certain form of leukemia or lymphoma, to
prevent complications from chemotherapy and tumor lysis syndrome - and not necessarily to
prevent gout. With high levels of uric acid in your blood, as a result of your disease, the uric acid
will collect and form crystals in your kidneys. This may occur during chemotherapy, and may
cause your kidneys to fail.
TREATMENTS OF HYPERURICEMIA:

12.  Gout, sometimes called gouty arthritis, occurs in about 20
percent of people with hyperuricemia.
 A rapid drop in uric acid levels can also trigger gout. Gout can
appear as isolated attacks, or flares.
 Some people experience chronic gout, which involves a
number attacks occurring over short periods of time.
 Gout can affect any joint in your body, but flares often first
appear in your large toe. Feet, ankles, knees, and elbows are
also common sites of gout.
 Gout attacks tend to occur suddenly, often at night. The attacks
peak in intensity in about 12 to 14 hours. Even untreated,
attacks of gout usually subside within two weeks.
GOUT:

13. If you’ve had hyperuricemia for several
years, uric acid crystals can form
clumps called tophi. These hard lumps
are found under your skin, around your
joints, and in the curve at the top of
your ear. Tophi can worsen joint pain
and over time damage your joints or
compress your nerves. They’re often
visible to the eye and can become
disfiguring.
TOPHACEOUS GOUT

15. SYMPTOMS OF GOUT:
joint
stiffness
severe
pain in
your joints
misshapen
joints
difficulty
moving
affected
joints
Redness
and
swelling

16. TREATMENTS OF GOUT:
•Benemid (probenecid)—Known as a uricosuric medication, this drug increases
excretion of uric acid in the urine.
•Zyloprin (allopurinol), Uloric (febuxostat)—These xanthine oxidase inhibitors
(XOIs) reduce the body’s production of uric acid.
•Zurampic (lenisurad)—prescribed with an XOI to increase its effects.
•Krystexxa (pegloticase)—Pegloticase is given by intravenous infusion. It changes
uric acid into a substance called allantoin that your body can eliminate easily. It is
reserved for people for whom other gout medications have not worked.

17. Uric acid crystals can cause a
buildup of stones in kidneys.
Often, the stones are small
and are passed in urine.
Sometimes, they can become
too large to pass and block
parts of urinary tract.
KIDNEY STONES

18. SYMPTOMS OF KIDNEY STONES:
pain or aching in your lower
back, side, abdomen, or groin
nausea
increased urge to
urinate
pain when
urinating
difficulty
urinating
blood in
your urine
foul-
smelling
urine

19. 
If you have kidney stones smaller than 5 millimeters (mm), your doctor may advise you to drink a lot
of water and take over-the-counter pain medications until the stones pass.
 Kidney stones that are 5 mm or larger are less likely to pass on their own. Some doctors prescribe
medications such as tamsulosin (Flomax) to relax the muscles in your urinary tract. This can make it
easier and less painful to pass the stones.

Extracorporeal show wave lithotripsy is a noninvasive procedure where ultrasonic energy or shock
waves are directed through your skin at the kidney stone. The shock waves break the large stone into
smaller pieces that can pass more easily through your urinary system.
 If the stones are greater than 10 mm, you may need to have them surgically removed.
 Ureteroscopic surgery is performed by passing a 2 mm scope through your urethra. It goes through
your bladder and directly into the ureters, which are the tubes connecting your kidneys to your
bladder.
 Your surgeon can then perform stone extraction. If the stones must be fragmented first, stents may
be placed to aid the flow of urine. This can help relieve pain and keep the ureters dilated to allow for
easier passage of fragmented or dissolving stones.
TREATMENTS OF KIDNEY STONES

20. Having low uric acid levels is rare.
The most prevalent medical condition causing low uric acid
levels is Fanconi syndrome, a rare kidney disease. In people
with this condition, the kidneys cannot absorb certain
nutrients into the body.
Fanconi syndrome can cause a lack of energy, dehydration,
and problems with the bones. A person with this condition will
have low uric acid levels because too much of this substance
is passing out of the body in the urine.
FANCONI SYNDROME

22. CAUSES OF FANCONI SYNDROME
Light chain
deposition
disease
Common causes of Fanconi syndrome in children are genetic
defects that affect the body's ability to break down certain
compounds such as:
Cystine (cystinosis)
Fructose (fructose intolerance)
Galactose (galactosemia)
Glycogen (glycogen storage disease)
Exposure to
heavy
metals such
as lead,
mercury, or
cadmium
Lowe syndrome, a rare genetic disorder of the eyes,
brain, and kidneys
Wilson disease
Dent disease, a rare genetic disorder of the kidney

23. The treatment of a child with Fanconi syndrome mainly consists
of the replacement of substances lost in the urine. Prominent
among these substances are fluids and electrolytes.
Dehydration due to polyuria must be prevented by allowing free
access to water; treat dehydration with either oral or parenteral
solutions.
TREATMENTS OF KIDNEY STONES
TREATMENTS OF FANCONI SYNDROME

24. • https://www.urmc.rochester.edu/encyclopedia/content.asp
x?contenttypeid=167&contentid=uric_acid_blood
• https://emedicine.medscape.com/article/2088516-overview
• https://www.medicalnewstoday.com/articles/uric-acid-
level#uric-acid-levels
• http://chemocare.com/chemotherapy/side-
effects/hyperuricemia-high-uric-acid.aspx
• https://www.healthline.com/health/gout-causes#risk-factors
REFRENCES
• https://emedicine.medscape.com/article/981774-treatment
• https://www.verywellhealth.com/what-is-uric-acid-189838