It is true that uric acid in our body is mainly excreted through the kidneys, but it doesn't mean that the kidneys of gout patients don't excrete acid anymore, which leads to increased blood uric acid. The cause of a person's elevated blood uric acid is very complex, not only the abnormal excretion of uric acid, but also contains an increase in uric acid synthesis, in most cases it is a combination of the two lead to abnormal uric acid metabolism.

We can look at the chart above, the so-called exogenous uric acid is mainly the purines in the food we consume after metabolizing the uric acid, while the other 80% of the uric acid source pathway is endogenous uric acid, which is produced by our body after metabolizing. The other 80% of uric acid is endogenous uric acid, which is produced by our body after metabolism. 70% of the uric acid in our body is excreted by the kidneys. SoIf a person's kidneys excrete uric acid abnormally and at the same time too much uric acid is formed, the two expedited very easily lead to an abnormal increase in uric acid. This makes as much sense as the one we all did as children thatMath problem with a pool that fills up and comes out at the same time, if a pool drain has a problem and the volume of water has increased, then it will definitely overflow.

So what exactly can cause abnormalities in uric acid?

Our normal male uric acid level should not exceed420In women, the normal level of uric acid should not be more than360After a woman enters menopause, normal values should rise to420If the continuousIf fasting blood uric acid is above normal on two non-same day measurements, then we can diagnose hyperuricemia。

There are many factors that lead to abnormalities in uric acid, and in simple terms the main cause of elevated uric acid is a disruption in the balance of uric acid metabolismup, and these out-of-the-box factors are mostly seen in the following situations:

●Excessive intake of high-purine foods: Uric acid is the end product of purine metabolism in the body, which is produced in our diet as well as by the body's own metabolism, and is produced if large sources of purines are consumed, such as large amounts ofRed meat, seafood (sardines, dried small fish, shellfish), animal offalThe body's naturally occurring purines will increase, which will invariably increase the burden on the kidneys to excrete uric acid. Occasional high-purine diets may aggravate the burden on the kidneys to a relatively small degree, but if over time, the perennial high-purine diet is a relatively large stimulus to the kidneys, and the kidneys will be able to absorb the purines.When there is also a problem with uric acid excretion, with the top squeezing the bottom, then uric acid is elevated。

●Excessive consumption of alcohol and sugary drinks: Excessive consumption of alcohol and sugary drinks, leading to elevated uric acid has a similar effect, many alcohol purine content is not particularly high, but if excessive consumption will affect the excretion of uric acid, and will lead to an increase in the metabolite uric acid. Intake of large amounts of sugary drinks, especially sugary drinks containing more fructose, will easily lead to elevated uric acid, one of the important factors in many young people with gout.
●genetic factor: The chances of hyperuricemia or gout are significantly higher in those whose grandparents had gout (A 2017 study showed that genetic factors have a high chance of causing uric acid abnormalities of about 23 percent(See Section 2.1.2.).

●obese: Many patients with abdominal obesity develop insulin resistance, which can also have a significant impact on uric acid metabolism, leading to the development of gout.

●physical exercise: There have been many studies from the 1980s that found that strenuous exercise can lead to abnormalities in uric acid metabolism, and that these strenuous exercises can lead to a decrease in uric acid excretion, which can lead to an increase in uric acid production. There has been a study showing that when badminton players have had two hours of intense exercise, the next day the uric acid in the original basis of an increase of about 40%, and the third day in the second basis of an increase of 20%, until a week after the uric acid will slowly return to normal.

●renal insufficiency: If the function of the kidneys is impaired, then the body will not be able to filter waste properly, which can lead to abnormalities in excretion. There are data showing that10% of patients with chronic kidney disease have gout。

●certain drugs: Many blood pressure medications and medications for heart disease can cause uric acid to rise. For exampleFurosemide and hydrochlorothiazideDiuretics such as these reduce the kidney's ability to excrete uric acid, causing a rise in uric acid, which can cause or induce uric acid abnormalities.B-blockers such asMetoprolol.Calcium antagonists such asNifedipine, amlodipineetc., all of which can reduce renal blood flow and uric acid excretion, thus causing or inducing hyperuricemic gout.

What kind of harm can prolonged gout or higher than abnormal uric acid lead to?

Prolonged gout or high uric acid can not only damage the patient's joints causing damage leading togouty arthritisand it can have a negative impact on the patient'sRenal function, cardiovascular functionas well ashypoglycemiaThe metabolism of all can be greatly affected. It may cause the patient to develop urinary stones, and in severe cases, there is a possibility of kidney failure. So treatment must be given.

So what should you do after developing abnormal uric acid, or even if you have gout?

●Change of lifestyle is fundamental: Any treatment for gout that does not involve positive changes in lifestyle and diet may be useless. It is advisable for those who have problems with uric acid to live a life of strictControlling the intake of medium and high purine content ingredients. RecommendationsNever drink alcohol or large amounts of sugary beveragesIn normal times, you should drink plenty of water, and keep it under control every day.2000 ml or more, so that more urine can be formed to promote the metabolism of uric acid; and it is important to appropriately increase the number ofIntake of skim milk and vitamin C-rich ingredientsThese two ingredients are negatively correlated with the rise of uric acid; and for those who are heavier, it is recommended that they exercise appropriately in their daily lives to control their weight, with fast walking, jogging and swimming as the main exercise options; in addition, if they have had an attack of gout, they try to beAvoid staying up lateAnd definitelyStay warm.Because cold irritation is one of the most common causes of gout attacks, the only way to improve your diet and lifestyle is to be proactive.

● It is recommended to go to the local hospital to consult a professional rheumatologist for a systematic examination.Kidney function and urinary uric acid levelsThis will enable us to better determine exactly which factor induced the patient to develop abnormalities in uric acid, and if it is due to theanomaly in excretionThe elevated blood uric acid that results canoral stimulantand if, as a result of metaboliccreate too muchThe elevated blood uric acid that occurs canOral synthetic inhibitors. If you have abnormal uric acid due to oral medications, then it is recommended that you consult your doctor to see if your medications can be adjusted.

summarize

The factors that lead to elevated uric acid in a patient are very complex, and it's definitely not the fact that the kidneys don't excrete acid anymore that leads to abnormal uric acid or gout attacks. In factUric acid abnormalities are often associated with kidney disease.If the blood uric acid is abnormal for a long time, it is very likely to lead to kidney stones, or even jeopardize the function of the kidneys and develop renal insufficiency; and if the renal insufficiency is induced by other illnesses, because of the abnormality of uric acid metabolism waste discharge, the uric acid will also appear to be elevated. It is recommended that patients with hyperuricemia or gout should have a scientific and systematic examination of their kidney function and uric acid metabolism with the help of a professional doctor, and then undergo a scientific and systematic treatment. And inWhen controlling uric acid, you must be careful to strictly control your diet and have healthy habitsIn this way, you can better cooperate with your doctor to control your uric acid and reduce gout attacks. The above is the answer to the question, if you have other doubts you can leave a message below, we can discuss together.

I adhere to the simple language to explain the complexity of disease knowledge Xie Xinhui, code word is not easy, if you agree with my views, please help point a concern or click a like it, if you or your family and friends also have uric acid abnormalities in this area of trouble, please forward this article to the need of their it, thank you!

Isn't the reason the kidneys don't excrete acid in gout patients that there is something wrong with them? That's not necessarily true.

What is "acid", uric acid, lactic acid, ketoacid are all acid. Judging from the gout disease, the "acid" here should refer to uric acid, gout and hyperuricemia patients often call themselves "acidophiles". Of course, from the point of view of kidney disease, "acid" also includes the problem of decreased blood bicarbonate concentration.

Is it possible for a gout patient's kidneys to not excrete uric acid at all? Yes. If it reaches the stage of renal failure or uremia, there may be a complete metabolic imbalance in the kidneys, but this is minimal; if this happens, the entire body's metabolism of the organism is completely out of control, and life-threatening conditions can occur.

Do all gout patients have problems with their kidneys excreting uric acid? No.Seventy percent of gout patients are caused by impaired uric acid excretion by the kidneys, 10% are caused by excessive uric acid production by the body, and 20% are a mixture of both impaired uric acid excretion and excessive uric acid production.

As a gout doctor, today I will focus on the reasons why gout patients develop impaired uric acid excretion by the kidneys, and how to treat the symptoms and take care of them on a daily basis; of course, I will also talk about the problem of decreasing blood bicarbonate concentrations, but only as a side note.

How do the kidneys excrete uric acid?

Some people say that uric acid is the "waste" of the human body; in fact, uric acid is also an indispensable physiological substance in human blood, which plays a physiological role in human metabolism such as antioxidant, immune enhancement and blood pressure stabilization. Of course, I am talking about the normal situation, that is, when the blood uric acid is below 420 μmol / L. The blood uric acid level is below 420 μmol / L.

How does uric acid come about? It is mainly produced by purine metabolism. There are two pathways of purine metabolism.endogenousThe first is the renewal metabolism of human cells, especially red blood cells, releasing purines through the action of enzymes to generate 80% of the body's daily generation of uric acid; the second is theExogenous.That is, the daily intake of purine-containing foods that are digested and absorbed by the body to generate 20% of the body's daily production of uric acid.

Uric acid has a certain amount in the human body, the human body uric acid pool (the total amount of uric acid) is 1200mg, every day through the endogenous metabolism and exogenous purine conversion to generate 750mg. and every day the excretion of uric acid in the 500~1000mg. that is to say, basically, the normal human body's amount of uric acid, the amount of uric acid production and excretion is to maintain a delicate balance.

Where there is production, there is excretion. Uric acid is excreted primarily through the kidneys and the intestines. Generally 2/3 of the uric acid is excreted in the urine, and 1/3 of the uric acid is excreted by the intestines, or broken down in the intestines by bacterial uric acid oxidase. Some people say that high blood uric acid is not also due to intestinal problems? In fact, at present, the rate of intestinal uric acid excretion mainly depends on the blood uric acid concentration, and cannot be the cause of high uric acid and gout.

So, how is uric acid excreted in the kidneys? We understand its mechanism, in order to know the kidney excretion of uric acid "failure" is likely to appear where?

The kidney excretes uric acid mainly through glomerular and tubular filtration, absorption, reabsorption, and secretion. This is shown in the figure below:

• Glomerular filtration:With the exception of a small portion of uric acid that is bound to protein, uric acid in the body is almost completely free to filter through the glomeruli.
• Proximal renal tubular reabsorption:More than 98% of the uric acid that passes through glomerular filtration is reabsorbed by the proximal renal tubule before secretion; uric acid reabsorption is increased if renal blood flow is reduced by dehydration, uremia, etc. When hypothyroidism occurs, renal blood flow is increased, uric acid reabsorption is reduced, and secretion is also reduced at the same time.
• Distal secretion from the proximal renal tubule:About 50% or more of the filtered amount of uric acid is secreted into the urine by the renal tubules, and the secreted uric acid accounts for the vast majority of the uric acid excreted in the urine, in addition to ketoacid, lactic acid, and other organic acids are also secreted in the distal portion of the proximal renal tubules so that when the concentration of these organic acids is elevated in the body, it can inhibit uric acid excretion.
• Reabsorption after renal tubular secretion:Approximately 40% to 45% of the filtered volume of secreted uric acid is reabsorbed, and finally 6% to 10% of the filtered volume of uric acid is excreted.

Causes of poor uric acid excretion by the kidneys?

After figuring out the principle of uric acid excretion by the kidneys, it is simpler for us to understand the reasons why the kidneys do not excrete uric acid well:

• If the production of uric acid increases and grows at a faster rate, but the kidneys have a limited ability to excrete it, even if more than the normal amount has been excreted, the production exceeds the rate of excretion, and there is a risk of increased uric acid;
• Alternatively, the kidneys may have decreased or slowed excretion of uric acid, but uric acid production is normal, and there may be increased uric acid;
• Alternatively, uric acid production increases and increases at a rate of speed, and uric acid excretion decreases and decelerates at the same time, again with elevated uric acid.

What happens when uric acid is elevated? When blood uric acid is greater than 420 μmol/L, monosodium urate in the blood is likely to be deposited in the joints, around the joints, in the kidneys and other tissues, which is called hyperuricemia. Hyperuricemia is an important biochemical basis for gout and the cause of progressive gouty arthritis, gouty stones, gouty nephropathy and kidney stones.

Reduced renal excretion of uric acid, which accounts for 90% of hyperuricemia and gout patients, mainly includes reduced glomerular uric acid filtration, increased tubular reabsorption, and reduced tubular uric acid secretion. The cause is mainly due to mutations in the genes of the enzymes involved in the renal excretion of uric acid, mainly the effect of the genes coding for the uric acid transporter proteins:

• Genetic factors such as uric acid reabsorption transporters:Urate anion transporter 1 (URAT1), glucose transporter protein 9 (GLUT9), and organic anion transporter 4 (OAT4) affect urate transport in the proximal renal tubule.
• Genetic factors such as the uric acid secretion transporter:Organic anion transporter 1 (OAT1), organic anion transporter 3 (OAT3), urate transporter (UAT), multidrug resistance protein 4 (MRP4), ABCG2, and N5,N10-methylenetetrahydrofolate reductase (MTHFR), which affects renal tubular, proximal tubular, and collecting duct secretion of urate.

• Dysregulation of water-sodium balance:Dehydration, sodium deficiency, diuretics, and uremia cause blood volume deficiency, increased reabsorption of uric acid, and decreased contouring, so the blood uric acid concentration is elevated.
• Excessive excretion of organic acids:Obstruction of urate transport, as in lactic acidosis and ketoacidosis, with elevated blood uric acid concentrations.
• Drugs that affect uric acid excretion:These are mostly organic acids that enter the urine and inhibit secretion and reabsorption through a common proximal organic anion transport pathway.
• Foods that affect uric acid excretion:Alcohol, primarily, reduces the excretion of uric acid and causes a sharp rise in blood uric acid because alcohol diverts pyruvic acid from sugar metabolism to produce lactic acid, which is a strong inhibitor of uric acid excretion.

The function of the kidneys is not only to excrete uric acid, but also to regulate blood pressure, excrete water and waste products, and regulate acid-base balance. Acids, including uric acid, lactic acid, and keto acid, are excreted through the kidneys.

If the ability of the kidneys to excrete uric acid decreases, then it also means that there is a problem with kidney function, the kidneys' ability to excrete acids decreases, and there is an increase in acids and a decrease in alkaline substances in the body. Until the kidneys are unable to compensate, metabolic acidosis occurs. In terms of indicators, this is manifested by a decrease in blood bicarbonate concentration.

Don't underestimate the problem of decreased blood bicarbonate concentration, which is relatively related to the progressive decline of kidney function in patients with chronic kidney disease and gouty kidneys. Therefore, after we figure out the reason for the decline in the ability of the kidneys to excrete uric acid, we still need to find out early that the kidneys do not excrete acid well.

How to detect poor kidney acid drainage early?

Kidney function problems are usually manifested when the kidneys do not excrete acid well. However, because kidneys are "ninja type" internal organs, even if there are problems, it is difficult to find out. When there are obvious pain or edema symptoms, the kidney problem is actually more serious. So, is it possible to see kidney problems through small daily symptoms?

The answer is yes. In general, when these symptoms occur, it is important to note that there is a problem with the kidneys that may lead to decreased uric acid excretion.

• Back pain:Mild low back pain may generally be present, sometimes unilateral or bilateral, in addition to mild edema.
• High blood pressure:Problems with kidney function can affect blood pressure, which fluctuates between 150 and 180 mmHg.
• Lackluster:Poor acid excretion by the kidneys will also slow down the elimination of other metabolic wastes, such as proteins, which may also be excreted competitively with uric acid leading to a decrease in the body's nutritional level and weakness, fatigue, and lack of energy.
• Foamy urine:Poor acid elimination by the kidneys and abnormal metabolism of proteins can produce proteinuria, which manifests itself as foamy urine.
• Frequent urination:Frequent urination, urinary urgency, painful urination and dysuria may be manifestations of pyelonephritis, but at the same time, it is necessary to observe whether there is an increase in protein in the urine.
• Vomiting:In the case of diabetes combined with kidney problems, there may be an increase in urea nitrogen in the blood, leading to irritation of the digestive tract mucosa, which can lead to feelings of nausea and vomiting.
• Gout:If gout is present, then it may also be a case of insufficient ability of the kidneys to excrete uric acid, leading to the deposition of urates.

Of course, the above symptoms can not be used as a judgment that the kidney must have problems, but need to pay attention. If you have the above symptoms, you need to be more alert, and it is better to go to the hospital for relevant examinations to rule out kidney problems. Generally speaking, the main tests done to check whether there is any problem with kidney problem and kidney acid excretion include:

• Blood creatinine (CR):If renal function decreases, it can be determined by blood creatinine, but blood creatinine is not an early indicator of renal function, and usually needs to be judged in combination with other indicators. The normal reference range of blood creatinine is 40~106 μmol/L.
• Blood Urea (UREA):Generally blood uric acid is commonly elevated only when renal function declines to less than 50%, and is informative for acute and chronic nephritis, severe pyelonephritis, and acute and chronic renal dysfunction due to various causes. The normal reference interval for blood urea is 1.7-8.3 μmol/L.
• Blood uric acid (UA):Blood uric acid is one of the most important indicators for the diagnosis of hyperuricemia and gout. Elevated blood uric acid represents a decrease in renal excretion or a rise in uric acid production. The normal reference range for blood uric acid is 202~420 μmol/L.
• Blood potassium:Elevated blood potassium occurs mainly in the middle and late stages of kidney disease, especially in the stage of renal failure. It mainly reflects an imbalance in the role of the kidneys in regulating electrolytes, and the accumulation of potassium ions causes no changes in cardiac function and the nervous system.

• Uric acid:Urinary uric acid is one of the main indicators to determine whether a patient with hyperuricemia has reduced uric acid excretion due to renal dysfunction or because of increased uric acid production. Generally, urinary urinary uric acid excretion under normal diet is less than 800mg/day belongs to the poorly excreted type, and more than 800mg/day belongs to the overproduced type.
• Urine Protein (PRO):If renal insufficiency occurs, the quantitative increase of urine protein, urine protein is a common symptom of renal disease, but also a relatively early indicator of abnormal renal function. The reference value of urine protein is: normal value is - or negative; abnormal is ± or +.
• Uric acid clearance (Cua):Uric acid clearance is also an indicator for determining the poor excretion type and the increased production type. Uric acid clearance <6.6 ml/min belongs to the poor excretion type of uric acid; uric acid clearance >12.6 ml/min belongs to the increased production type of uric acid; and uric acid clearance <6.2 ml/min belongs to the mixed type.
• Urine Routine:Patients who generally have more than one problem with renal excretion of uric acid may find varying numbers of red blood cells, white blood cells, epithelial cells, and granulocyte tubular patterns on urine sediment examination.
• Ultrasound:Ultrasound can provide an understanding of the structure of the kidney and can also provide a relatively accurate determination of whether the cause of renal insufficiency is prerenal, nephrogenic, or postrenal.
• Carbon dioxide:Carbon dioxide testing is common in dialysis patients, patients undergoing kidney transplantation, and patients with eGFR <40-50mL/min, i.e., chronic kidney disease stage 3 and beyond, with a normal reference interval of 22-29mmol/L.

In addition to the above relevant tests, it also includes urine specific gravity, urine osmolality, urine sodium, sodium excretion fraction, urine bacteriological examination, radionuclide renal imaging, nephroscopy, ureteroscopy, cystoscopy, renal biopsy and so on to make a check on the ability of renal acid excretion, so as to make a comprehensive judgment on the renal function.

What to do if you find a problem with acid drainage in your kidneys?

If you find a problem with acid excretion in the kidneys, then you need to correctly adjust the treatment as well as consolidate the treatment in a timely manner, and correctly bring down the indicators of urinary protein, occult blood, blood pressure, etc., as well as inhibit the inflammatory response of the kidneys.

For gout patients, the first thing to do when there is a problem with kidney acid drainage is to lower uric acid treatment; in addition, if there is a problem with blood pressure, at the same time, blood pressure lowering treatment should also be carried out. The main ways to adjust the kidney problems include:

• Keep your blood pressure up:Blood pressure is an independent factor leading to kidney problems, the higher the blood pressure the worse the blood supply to the kidneys, so you need to make sure that the kidney blood flow environment is normal, so that the blood pressure stays between 80 and 130 mmHg.

• Keep urinating:It is not recommended to use diuretics without doctor's supervision, because diuretics tend to lead to elevated uric acid; it is generally recommended to maintain a daily urine output of more than 2,000 ml in the absence of kidney stones or uric acid nephropathy to promote uric acid excretion from the urine and to reduce the production of urinary stones.
• Control of diet:Although in order to ensure adequate renal nutrition does not emphasize the low purine diet, but for gout patients, the daily purine diet is still controlled within the total amount of 200mg, in addition to animal offal, thick meat soup, crustacean seafood and other very high purine food or try to avoid; control sodium intake, so as not to increase the burden on the kidneys, the daily sodium intake should not be more than 6g; control fructose intake, fructose is able to Increase uric acid production, so it is recommended to eat less high fructose drinks, fruits and cookies and other foods; consumption of high-quality proteins, such as milk, eggs in the amino acids, less use of other animal proteins.

• Control of alcohol consumption:Alcohol consumption can not only lead to the accumulation of lactic acid in the body, thus producing competitive inhibition with uric acid, but also able to directly produce uric acid, large amounts of alcohol consumption is not only a direct result of a significant increase in uric acid, but also can lead to a decline in the ability of kidney function.

• No blind supplements:Some people think that they need to tonify their kidneys if they have problems with kidney function. But kidney tonic should not be blind. In Chinese medicine, kidney tonic is only needed in cases of kidney deficiency and kidney loss; it does not only refer to problems in kidney function. Blindly taking tonic may lead to a further decline in the excretory capacity of kidney function.

• Regulating uric acid reduction:The first choice of drugs for abnormal renal acid excretion is pro-uric acid excretion drugs that inhibit tubular reabsorption of uric acid. Generally speaking, benzbromarone can be used in patients with gout who are less than 60 years of age, have a creatinine clearance of more than 80 ml/min, have a 24-hour excretion of uric acid of less than 800 mg on a daily diet, and do not have a history of renal calculi; and drugs that alkalize the urine with sodium bicarbonate and potassium sodium citrate need to be used to Maintain urine pH between 6.2 and 6.9. For mixed patients or patients for whom crude uric acid excretory drugs are not applicable, drugs that inhibit uric acid production such as allopurinol and febuxostat can be used, and febuxostat is more applicable especially in patients who are checked for renal insufficiency.

• Traditional Chinese Medicine (TCM) treatment:For improving renal function, especially for patients with gout combined with renal insufficiency, the treatment methods of dispelling wind, removing dampness, activating blood, clearing heat, supporting the right and dispelling the evil can be used for symptomatic diagnosis and treatment.
• Treating the causes of renal insufficiency:For example, controlling blood pressure, lowering blood lipids, lowering urinary proteins, and improving renal hemodynamics can slow down the rate of progression and deterioration of renal insufficiency.
• Perform aerobic exercise:Aerobic exercise such as walking, jogging, slow cycling, tai chi, and swimming ≥5 times per week for 30 minutes of sustained moderate-intensity physical activity each time, and those with severe disease need to start with low-intensity exercise for several short (~10-minute) periods.

In conclusion, for gout patients who have problems with the kidney's ability to excrete acid, uric acid-lowering treatment needs to be combined with kidney-protecting treatment, medication with life modification, and dietary treatment with exercise therapy.Accelerates metabolism and protects kidneys from acidityDoing it together is the key.

It is not easy to code, I am the gout doctor Liu Liangyun who insists on health science in the spare time of sitting, I hope my answer can satisfy you. If you think it's not bad, like it and share it with your friends who need it.

Gout originates from the body of uric acid exceeds the standard, and the body of uric acid exceeds the standard is very often due to uric acid excretion is not smooth. The excretion of uric acid in the body is very dependent on the kidneys, the ability of the kidneys to excrete uric acid often determines the level of uric acid in the body to a certain extent.

But many times, the kidneys are blocked from excreting uric acid, resulting in elevated uric acid, gout attacks, and even serious complications. What exactly are all the reasons for this, today we will talk about it.

Elevated uric acid in the body, the probability is that the kidneys are failing

When we first hear about gout, we always associate it with "illness comes in through the mouth". Is it true that high purine food "eat more", so the production of uric acid, uric acid level is high?

Exogenous uric acid accounts for only a small portion of uric acid production

While exogenous uric acid produced through eating does exist, it only accounts for a small portion of uric acid production, about 20%. Instead, the majority of uric acid (80%) production comes from the body's cells running metabolism week after week.

The excretion pathway of uric acid is also simple: 2/3 of it is excreted in urine through renal filtration, and the other 1/3 is excreted in feces through the intestinal tract or is broken down by bacterial uric acid oxidizing enzymes in the intestinal tract. The latter has a relatively fixed capacity for uric acid excretion, while the former's capacity can be elevated on demand. Because the kidneys are often known as "hard-working honest people", if you eat a meal of seafood today, uric acid production suddenly rise, the kidneys will also work overtime to the excess uric acid to the filtration, excretion of the body to maintain a relatively stable level of uric acid.

It should be reminded that some organizations or individuals advertise that sauna and sweating can excrete uric acid, which is completely wrong. Uric acid discharged through sweat is almost negligible, if not timely hydration, but will concentrate the blood, elevated uric acid.

而It has been found through research that 80-90% of patients with hyperuricemia and gout have impaired uric acid excretion. In other words, friends with high uric acid have a high probability of having kidney problems.

What factors affect uric acid excretion by the kidneys?

1. Effects of organic acids

For example, lactic acid, produced after strenuous exercise, can impede the transport of urate in the kidneys. Therefore, patients with lactic acidosis are prone to impaired uric acid excretion in the kidneys. Patients with advanced age, chronic alcoholism, diseases such as heart disease, asthma, anemia, hepatic and renal insufficiency, hypoxemia, respiratory failure, chronic beryllium pneumoconiosis, acute alcoholism and diabetic patients using biguanide glucose-lowering drugs are prone to lactic acidosis.

Also, patients with ketoacidosis are prone to impaired uric acid excretion. Diabetics, excessive alcohol consumption, and excessive dieters are prone to ketoacidosis.

2. Disorders of water-sodium balance

Dehydration, sodium deficiency, diuretics, uremia and other causes of blood volume insufficiency, then uric acid reabsorption is increased, the contour is reduced, so the blood uric acid concentration is increased.

For example, prolonged peritonitis and pancreatitis can result in the formation of large amounts of ascites, intestinal obstruction causes large amounts of intestinal fluid to collect in the intestinal lumen, and pleurisy results in the formation of large amounts of pleural fluid, which can lead to hypotonic dehydration.

Large amounts of hypotonic fluid can be lost through the skin, leading to hypertonic dehydration, as in the case of hyperthermia, sweating, large amounts of sweating due to exercise, hyperthyroidism, and extensive burns.

While there are two main types of sodium deficiency, the first type of poor diet leading to excess intake is less common. The second type of excessive loss is seen in patients on diuretics or in patients with adrenocortical insufficiency and glucocorticoid deficiency.

3. Drug effects

Some drugs that affect uric acid excretion are themselves organic acids, and they enter the urine primarily through a common proximal organic anion transport pathway that inhibits both secretion and reabsorption. The net result of uric acid excretion, as a result of the degree of action of these two aspects, such as aspirin, small doses inhibit uric acid secretion, causing uric acid retention, large doses impede reabsorption, uric acid excretion occurs.

Diuretic therapy has been an important cause of secondary hyperuricemia in the population in recent years. Diuretic-induced hypovolemia leading to increased tubular reabsorption of uric acid and decreased uric acid secretion are also possible mechanisms of diuretic-induced hyperuricemia. There are also a number of drugs that cause hyperuricemia by reducing renal excretion of uric acid through different mechanisms, such as pyrazinamide, niacin, ethambutol, and cyclosporine.

4. Diseases

Inadequate blood volume in patients with adrenal insufficiency and nephrogenic uremia is an important cause of hyperuricemia. Alcoholic ketosis and diabetic ketoacidosis can cause lactic acidosis, which leads to hyperuricemia.

In contrast, the renal basis of hyperuricemia caused by chronic lead poisoning, polycystic kidney disease, hyperparathyroidism, hypoparathyroidism, pseudohypoparathyroidism, and hypothyroidism is unclear.

5. Renal insufficiency

Renal insufficiency is a separate disease because it can be both the "cause" and "effect" of the kidney's failure to excrete acid. Renal insufficiency is a common cause of secondary hyperuricemia, and long-term hyperuricemia is also prone to uric acid nephropathy, which leads to impaired renal function.

Therefore, once uric acid nephropathy occurs, both hyperuricemia and renal insufficiency are prone to interact with each other, accelerating the progress and rapid deterioration.

6. Mutations in genes for enzymes involved in the excretion of uric acid by the kidney

Uric acid excretion in the kidney is assisted by uric acid transporter proteins. In recent years, human genome wide association study (GWAS) has identified numerous loci associated with the development of hyperuricemia and gout, and these single nucleotide polymorphisms are mainly concentrated in the genes coding for uric acid transporter proteins, among which SLC2A9 is considered to be the most relevant factor for hyperuricemia and gout.

Urate transport in the proximal renal tubule

With the development of molecular genetics and molecular biology theories and techniques, further elucidation of the pathogenesis of primary hyperuricemia and gout from the molecular level may provide a scientific basis for its prevention and treatment, which will take time.

summarize

Abnormal levels of uric acid excretion by the kidneys are basically present in hyperuricemia and gout populations. However, there are numerous possible causes of impaired uric acid excretion by the kidneys, with strong and weak influences, multiple simultaneous factors, or the presence of a single factor capable of upsetting the equilibrium of uric acid levels in the body. Seek professional doctor, understand the medical history in detail to rule out one by one, and intervene accordingly, in order to achieve the ideal effect of lowering uric acid.

I am Dr. Qiao Fang from the Department of Rheumatology and Immunology, formerly a general practitioner at Sichuan Provincial People's Hospital. It is not easy to organize and publish! If you think it is helpful to read, please help point a concern or point a praise; if you have a different point of view, you are also welcome to leave a message below, we can discuss together; you can also be transferred to your side of the need for friends; thank you!

First of all, uric acid is a substance produced by the body after metabolizing it. Since it is a metabolized product, it is important to know how it is produced and removed from the body, where it comes from and where it goes.

The source of uric acid, its processing plant in the body's liver. An important raw material for the production of uric acid is purine, and there are two main sources of purine, one is endogenous, is the body's own metabolism out of the body, such as eating carbohydrate foods, fats, proteins through the physiological metabolism, the final product is purine, accounting for the body of the total amount of purine 80%. The other is exogenous, it is from the food intake, such as animal offal, seafood, fish, etc., the food itself is higher, accounting for 20% of the total amount of purine in the body.

These purines to the human body, in the role of xanthine oxidase, etc., and synthesized in the liver, uric acid in the body to play its beneficial functions, such as participating in the oxidation of the brain, limbs, of which, 60% involved in the metabolism of the remaining 40% need to be eliminated from the body, every day, about 500 ~ 1000mg to be excretion, and elimination of uric acid, the total amount of 2 / 3 is through the kidneys, and 1 / 3 is in the intestinal decomposition elimination. It is broken down and eliminated in the intestines. This is the normal metabolic pathway of uric acid in our body.

Our bodies are amazing at functioning and tend to synthesize as much as they need, with the excess being excreted from the body. If there is a problem in any part of this metabolic pathway, an increase in blood uric acid can occur. Large amounts of urate crystals are then formed in the body, and when the crystals are released they can start the development of acute inflammation and eventually small joint pain.

These links include:1, enzyme and metabolic defects, that is, increased activity of PRPP synthase or partial or total deficiency of HGPRT, both of which make excessive production of uric acid.2, increased purine intake:drinking alcohol and consumption of high-purine foods, such as excessive intake of animal offal, seafood, etc..3, decreased renal excretion, decreased clearance, the common causes of drugs, poisoning, or ketone bodies, lactic acid, and other factors, so that the excretion of uric acid is inhibited and ( or) increased absorption. Most commonly seen in the accompanying chronic nephritis, hypertension, dehydration, diabetes mellitus ketosis or acidosis, hypothyroidism or hyperthyroidism, the use of tabs diuretics and insulin resistance.

So it's not just that the kidneys don't excrete uric acid in gout sufferers, it's that they excrete less of it, or consume too much of it, synthesize too much of it, etc.

Learn more about health and follow Dr. Xiao Xiao.

Why the kidneys don't excrete uric acid anymore.

You work every day, if according to the number, you can only do 100 work every day, but you do 150 work every day, one day is fine, two days is fine, but every day, when one day you can not do, can only do 70 work? What if you can only do 50 hours of work? At that time, what will you do, in a direct, if a person can run five kilometers, but he had to participate in the marathon race, the result will be the news rumors that someone in the marathon race process, sudden death.

So is the human kidney, ah, he also has to work ah, but if you let it work overtime every day, how will it be over time? The function of the kidney in Western medicine is very simple.

(1) Production of urine and excretion of metabolites

(2) Maintain fluid balance and acid-base balance in the body.

(3) Endocrine function.

Take a look at the function of the kidneys in the eyes of a TCM practitioner. Scare you to death, huh?

Physiological functions of the kidney

1. Kidneys hide essence: Kidneys hide essence means that the kidneys have the role of storing and sealing the essence of the human body.

(1) Concept and Classification of Sperm

(1) the concept of essence: essence, also known as essence, the essence of the broad sense of the composition of the human body to maintain the growth and development of the human body, reproduction and the functional activities of the organs of the tangible essence of the general term of the essence of the broad sense of the essence of the endowed with the parents of the life of the material, that is, the innate essence, as well as the acquisition of the essence of the water and grains, that is, the essence of the innate.

In the narrow sense, the essence is the subtle substance endowed by the parents and stored in the kidneys with the function of reproduction, also known as the essence of reproduction.

② Classification of Sperm: In terms of the source of Sperm, it can be divided into two categories: innate Sperm and acquired Sperm.

Innate essence: Innate essence is also known as the essence of the kidney. Innate essence, endowed with parents, innate, is reproductive reproduction, constitute the original substance of the human body. The essence of the latter day: the essence of the latter day is also known as the essence of the five viscera and six bowels. The essence of the latter day, from the water and grain essence, from the spleen and stomach and instill both the five viscera and six bowels.

(2) Physiological functions of essence: The essence in the kidneys not only promotes the growth, development and reproduction of the organism, but also participates in the production of blood and improves the organism's ability to resist disease.

①Promoting reproduction: Kidney essence is the primordial substance for embryonic development, and it also promotes the maturation of reproductive functions. The production, storage and excretion of kidney essence play an important role in reproduction.

② promote growth and development: birth, growth, strength, old age, has been the natural laws of human life. People from birth through development, growth, maturity, aging and death before the survival of the body time, called life expectancy, people to the five organs for this, and the kidney for the root of the five organs. The essence stored in the kidney is the foundation of life, and plays a leading role in the process of human growth and aging.

(iii) Involved in blood production: Kidney hides essence, which can produce marrow, and essence and marrow can be transformed into blood. (iv) Resisting the invasion of external evils: Kidney essence has the function of resisting external evils and saving people from diseases. If the essence is full, the vitality is strong, and the defense is solid and dense, the adaptability is strong, and the evil is not easy to invade. On the contrary, if the essence is deficient, the vitality is weak, the defense is not solid, the adaptability is weak, and the evil invades and causes disease.

2. The kidney is the master of water and fluid: water and fluid is the general term for normal fluids in the body. Kidney master of water, in a broad sense, refers to the kidney as a water organ, referring to the role of the kidney with the hidden essence and regulation of water. From the narrow sense, refers to the kidney presides over and regulates the body's water metabolism function.

3. Kidney main gas: Na, fixed, the meaning of acceptance. Kidney main gas, means that the kidneys have to take in the lung inhalation of gas and regulate the role of respiration.

4. The main body of yin and yang, the kidney is the basis of the five viscera and six bowels

The above excerpts from the functions of the kidney from the Internet, too much, deleted a lot, which also shows that in Chinese medicine, how important the kidney, but can cut a kidney. In this regard, Chinese medicine said that the kidney is not simply Western medicine said that the kidney.

+ We are still according to Chinese medicine, ah, the kidney if you want to put so many functions are played out that have to have enough yang qi ah. What is Yang Qi? What is the role of Yang Qi? Yang qi is like the external electricity, if there is no electricity, all the electrical appliances can not be used. Yang qi in the human body is so important, there is a defensive role, the role of warmth, three gasification, four promote the role of five solid ingestion, etc., people's thought activities, diet, talk, and so on, all of the power to maintain life activity comes from the yang qi. Nei Jing said yang qi if the sky and the sun, lost its place, then folded life and do not shine. Think about it yourself, if the sun is gone, then we also quickly migrate to Jupiter. We know the role of yang qi, also know the importance of yang qi, that is to say, people are consuming yang qi ah, but also in the production of yang qi, but if the production of less than the consumption of fast, it is very dangerous.

Spleen is only a place to produce Yang Qi, if the day's Yang Qi consumption is 100, and three meals a day a total of 130 Yang Qi, remove the consumption of 30 Yang Qi, the 30 Yang Qi will be stored in the kidneys, so that the kidneys is the battery, so that the kidneys for the water, by the essence of the five viscera and six bowels of the hidden.

On the contrary if I still consume 100 a day but I can only absorb 70 or less yang from my three meals and diet, then I am consuming more than I am absorbing, and then I will replenish those 30 yang from the kidneys. In the long run the kidneys are deficient because the stock inside the kidneys is also counted ah.

In this way, our kidney function declines, and the decline in kidney function is reflected in the impact on the metabolism of water and fluid. Therefore, the acidity is also affected.

This question is asked professionally. Why gout occurs, its basic physiological basis is the problem of hyperuricemia, why hyperuricemia occurs, the main reason is that the body's uric acid metabolism is abnormal, a lot of high uric acid problem of friends, and the kidneys for the excretion of uric acid is not good have a lot to do with.

Uric acid is a physiological metabolic substances in our body, its main source is our body cell metabolism produced by nucleotides and other substances, in a variety of enzyme catalysis, is gradually oxidized, and ultimately the formation of urate in the blood, and a small portion of uric acid (about 20% or so), is the external intake of food in the purine material, after the metabolism of the body to be converted.

Generally, the concentration of uric acid in our body will maintain a relatively balanced state, the excess uric acid produced every day will be excreted, the excretion of the pathway usually has two aspects, one is our renal system, in the process of blood filtration and reabsorption, will be excess uric acid excreted into the urine, through the urine excreted, which is the main pathway of excretion of uric acid, the amount of uric acid discharged accounted for the excess of uric acid This is the main way of uric acid excretion, and the amount of uric acid excreted accounts for about two-thirds of the total amount of excess uric acid, while there is also a part of excess uric acid, will be excreted through the intestinal tract through feces.

The reason why the problem of high uric acid occurs is related to the excessive production of uric acid, but the more important reason is often caused by the poor excretion of uric acid, especially the decline in the kidney's function of excretion of uric acid. According to clinical statistics, about 85% of patients with high uric acid belong to poor uric acid excretion type, 5% belong to excessive uric acid production type, the remaining 10% belong to both comprehensive high uric acid problem, that is to say, about 95% of patients with hyperuricemia, there are poor excretion of uric acid by the kidneys.

Uric acid is poorly excreted by the kidneys, not that the kidneys do not excrete acid, our kidneys have millions of renal units composed of blood flowing through our kidneys, the glomeruli will form a filtration of blood, the renal tubules will be filtered blood selective reabsorption, if the kidneys for the filtration and reabsorption of uric acid problems, the amount of excretion has become less, the reabsorption of the amount of larger, back to the blood circulation of uric acid will be more, of course, there will be a high uric acid problem. Uric acid will be more, the uric acid will not be excreted effectively, of course, the problem of high uric acid will occur.

Fundamentally, the reason why the kidney excretion of uric acid is reduced, mainly because the kidney for uric acid excretion function has certain problems, this excretion function decline, but also a warning of the decline in kidney function, compared to the emergence of proteinuria, glomerular filtration rate decline and other indicators, the blood uric acid, the kidneys for the excretion of uric acid reduced function, often appear earlier, but also more worthy of our attention! It is also worthwhile to pay attention to it.

For such a problem, conditioning the kidneys, so that our kidneys to restore the uric acid excretion function, is often very difficult to control the problem of high uric acid, it is more important to control the production and excretion of uric acid from a variety of aspects, such as daily life on the dietary control of purine intake, abstaining from alcohol, weight control, to avoid staying up too late, and to strengthen the movement and other aspects of uric acid are to strengthen the regulation of the important life of the regulation, in addition, in the In addition, in the case of kidney function has not yet appeared drinking water control contraindications, moderate drinking more water, more urination, is also to promote uric acid excretion, reduce high uric acid is one of the good ways.

Therefore, although the decline in the excretion of uric acid by the kidneys is one of the main causes of high uric acid gout, but for the control of uric acid, we still need to be comprehensive and multi-faceted regulation and control, for friends who have had an attack of gout with high uric acid, or without an attack of gout, uric acid value of more than 540 μmol/L, in the life of the conditioning at the same time, but also pay attention to the reasonable use of medication to regulate the level of uric acid, if you can actively and reasonably control high uric acid, not only can reduce the risk of gout, but also very important for the protection of kidney health. If you can actively and reasonably control high uric acid, not only can you reduce the risk of gout attacks, but it is also very important for the protection of kidney health. Kidney health problems lead to the elevation of uric acid, and high uric acid uncontrolled for a long period of time will gradually affect kidney function, leading to interstitial changes and hardening of small blood vessels in the kidneys, which further affects the kidney health, so high uric acid must be actively controlled in order to reduce high uric acid. Therefore, high uric acid must be actively controlled in order to reduce the health hazards caused by high uric acid to the body in all aspects.

It's not that you don't excrete uric acid, it's that you excrete less uric acid. Why?

As we know, patients with primary hyperuricemia and gout are mainly categorized into two types clinically. One is the type with excessive uric acid production, accounting for about 20% of the total; the other is the type with reduced uric acid excretion, accounting for about 80% of the total. Of course, among these two, there are many who have both, also called mixed type.

From the above, it can be seen that patients with hyperuricemia and gout due to decreased uric acid excretion make up the majority of the gout patient population. Therefore, researching and treating decreased uric acid excretion is a more effective way to treat gout patients.

However, what we call reduced uric acid excretion causing gout is determined solely on the basis of renal excretion and clearance of uric acid. And in fact, our body in general, two-thirds of uric acid is excreted from the kidneys through urine, and the other one-third of uric acid is excreted outside the kidneys, for example, our digestive tract can excrete a part of uric acid, for example, our skin can also excrete a very small part of uric acid through sweating.

Only, we have basically not paid much attention to the above mentioned pathways of uric acid excretion. It is the kidneys that have received the most attention and research. It is believed that the role of the kidneys in the excretion of uric acid is the most critical factor in the cause of gout.

Therefore, the kidneys are the main organ that regulates the concentration of uric acid in our body.

The excretion of uric acid by the kidneys is regulated mainly by reabsorption and secretion in the renal tubules. Normally, our kidneys filter almost all of the uric acid in the blood flowing through the glomeruli through the filtration membrane into the renal tubules. The renal tubules in turn reabsorb most of the uric acid back.

In addition, the renal tubules of our kidneys are able to secrete uric acid and excrete it out of the body. When the secretion function is enhanced, the excretion of uric acid increases and the blood uric acid concentration decreases; when the secretion function is reduced, the excretion of uric acid decreases and the blood uric acid concentration increases, and when it is too high, hyperuricemia or gout is formed.

It is, in fact, the process of renal excretion of uric acid, including glomerular filtration of uric acid; reabsorption of uric acid by the proximal portion of the proximal tubule; secretion of uric acid by the distal portion of the proximal tubule; and even reabsorption of uric acid after secretion by the distal portion of the proximal tubule.

When renal tubular function is abnormal, reabsorption of uric acid is increased and a decrease in uric acid excreted in the urine occurs.

Therefore, when the glomerular filtration rate decreases, the reabsorption of uric acid by the proximal portion of the tubule increases, and the secretion of uric acid by the distal portion of the tubule decreases, all of which result in varying degrees of increased blood uric acid.

It has been found that normal individuals affect tubular reabsorption and secretion of uric acid, which is closely related to our genetic factors. We will not discuss this in depth here.

Since the causes of primary hyperuricemia and gout patients are closely related to our genes and are congenital. So there is nothing we can do about it?

No, for patients with hyperuricemia, we can absolutely have multiple ways to reduce our blood uric acid. For example, in terms of diet we can completely reduce the intake of high-purine foods; for example, we can appropriately increase the amount of water we drink in order to increase the excretion of uric acid; for example, we can completely increase our exercise appropriately in order to increase the metabolism of uric acid; for example, we can completely avoid the drugs, foods and alcohol that are related to the tendency to reduce the excretion of uric acid.

There are many high-purine foods, commonly seafood, old-fashioned soups, beer, soy foods, and so on.

Drinking more water and urinating more is a good way to promote uric acid excretion, which not only helps to promote uric acid excretion, but also helps to reduce the risk of uric acid kidney stones brought about by high uric acid.

Appropriate increase in exercise, not only can make uric acid can be well metabolized, but also can increase the amount of sweating, but also be able to eliminate part of the blood uric acid.

Often some patients say, beer contains high purine drinking, it is best not to drink, and white wine can always drink it? In fact, not, white wine can also promote the production of uric acid in the body, and alcohol metabolites will also affect the excretion of uric acid. At the same time, many drugs can affect the excretion of uric acid. For example, some diuretic drugs, anti-tuberculosis drugs, antihypertensive drugs, immunosuppressants and so on. Commonly used are hydrochlorothiazide, pyrazinamide, indapamide, cyclosporine. Because the use of drugs is often in compliance with the doctor's schedule. So, we just need to tell the doctor that we have hyperuricemia or gout, and the doctor will take care of the optional medication.

However, many of our patients find that hyperuricemia and gout cannot be completely controlled even though the above requirements are strictly followed. It is necessary for us to cooperate with uric acid-lowering drug treatment for a long time.

It is not that uric acid is not excreted anymore in gout patients, but the emission is reduced, or the excretion is not up to the level of production. Uric acid is a metabolic product of the body, 70% of the uric acid is excreted from the kidneys, therefore, if the renal excretion is reduced, it is easy to trigger hyperuricemia.

The truth is that most gout is triggered by impaired uric acid excretion, and there are many causes of impaired uric acid excretion. Such as:

• Alcohol consumption: the number one cause of gout attacks in Chinese men.

• Strenuous exercise: an important cause of gout attacks in Chinese adults.

• High-fructose diets: common in young adults and adolescents, and strongly associated with high intake of beverages.

• Medications: The most common is low-dose aspirin, which inhibits the excretion of uric acid in the kidneys, leading to elevated uric acid levels.

Most hyperuricemia is closely related to poor lifestyle habits.

Seeing this many friends will be concerned about how can we promote uric acid excretion by kidney? Dr. Zhang has the following suggestions.

• Increase water intake: To increase uric acid excretion by the kidneys, the amount of urine must be increased, so more water must be consumed. It is recommended that people with hyperuricemia should hot shot at least 2000~2500 ml of water per day, mainly cool boiled water, and not consume beverages containing fructose and alcohol. In addition, a shock water intake of at least 500 ml once in the morning, midday and evening can promote urine formation and increase uric acid excretion.

• Control weight in the normal range: weight gain, will trigger insulin resistance, inhibit the excretion of uric acid. Many obese people have problems with uric acid, so it is important for those with hyperuricemia to control their weight within the normal range.

• Reasonable exercise, reasonable exercise, can increase cardiopulmonary function, promote blood circulation, increase urine output, promote uric acid excretion, it is recommended to take moderate intensity aerobic exercise, avoid a lot of sweating exercise. Exercise 5~7 days per week, each exercise 30~60 minutes can be. Do not engage in high-intensity exercise, high-intensity exercise not only can not promote uric acid excretion, but also easy to increase the formation of uric acid, instead of inducing gout.

• Quit bad habits, many bad habits on the excretion of uric acid have an impact, which is the most serious to drink alcohol, alcohol intake in the body will increase the consumption of more ATP, in the process of producing a large amount of uric acid, at the same time drinking process produces a large amount of lactic acid, inhibit the excretion of uric acid, resulting in increased uric acid levels. Therefore, friends with hyperuricemia must limit alcohol consumption, especially beer, which has the greatest impact on uric acid levels.

• Adopt a healthy diet: When your blood uric acid is high, you must adopt a healthy diet, otherwise your kidneys will not be able to excrete as much as your constant intake will not be able to bring down the uric acid level. It is recommended to live on low purine foods, while controlling the intake of calories and alcohol.

• Treatment of chronic diseases in: hypertension, diabetes, hyperlipidemia and hyperuricemia together known as the "four highs". These diseases work hand in hand to promote each other, and together they promote the occurrence and development of gout. If you are a patient with hyperuricemia, in addition to the treatment that can be taken to inhibit uric acid, it is also necessary to treat several other chronic diseases to achieve a stable state in order to effectively control uric acid levels.

With the measures described above, most patients can achieve good control of their uric acid levels, which can usually be brought down to around 60 through the influence of a healthy lifestyle. If the desired category is not yet reached, it is recommended that you take uric acid-lowering medication.

That's all we have to talk about for today's issue, I'm Dr. Chang, we'll see you next time.