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I see many reference to the blood mg/dl levels, but having a hard time figuring out of the urine mg/dl means anything.
I know that if the blood level is below 6, the crystals start to dissolve. Does the same apply to the urine levels (UAU) ?
Below are my recent labs. I started Uloric in May of this year – was suffering when I started it.
Felt pretty good for a few weeks in September – really felt like I was getting better, but since early October have been in constant pain – taking Advil to make it through everyday.
I have several fingers and toes that are enlarged and have been that way for years. Shoulder, back, wrists, and other spots in my hands also hurt.
My hope is that all the pain now is really gain because the stuff is dissolving. The pain does seem different than when the joints initially flared up – it is not as intense, but it seems like they all hurt.
I have been on the roller coaster with this stuff for about 7 years – just turned 43. Back in 2006 I took Allopurinol for about a year but quit because it made me feel strange. That was probably a mistake on my part – one that gets made commonly from what I have read since. Feeling strange is better than feeling like hell.
What do you think gout pal ?
Thanks for any feedback – John
May 2009
Uric acid urine (UAU) 17.8 mg/dl
Uric acid 24 hour 774.3 H mg/24 hr range of normal is 250.0 -750.0
Uric acid Serum 4.8 mg/dl
Begin Uloric
June 2009
Uric acid urine (UAU) 6.7 mg/dl
Uric acid 24 hour 304.8 H mg/24 hr range of normal is 250.0 -750.0Uric acid Serum 2.5 mg/dl
October 2009
Uric acid urine (UAU) 5.2 mg/dl
Uric acid 24 hour 270.4 H mg/24 hr range of normal is 250.0 -750.0
Uric acid Serum 2.4 mg/dl
Hi John, I've moved your message here from a topic in gout cures, as it really deserves a new discussion.
I'll be back later with a view on urine uric acid levels.
What concerns me for now is your starting blood uric acid level. Not the number of a gout sufferer that I recognize. Was there more to the gout diagnosis?
Yes, there was more to the diagnosis.
I had my hand aspirated (fluid taken from the swollen joint with a needle) a couple different times. First time there was no crystals. the second time MSU crystals were identified in the fluid.
I also have the tophi on the helix of my ear – not terrible, but there are about 6 or 7 small hard bumps – like shot pellets on the edge of my ear. I have never had any break through the skin. But, they look like classic gout tophi on the ear.
I have had my doubts about the diagnosis over the years, but with the tophi on the ear, the crystals in the hand…it seems accurate.
In my 20s and 30s, I drank plenty of beer – pale ale.
My mom tells me that my grandfather (who died before I was born) couldn't make fists – the belief has been from working his farm so hard. My uncles worked the farm too (with more modern equipment), but still a lot of hands on labor and they can may fists. I work a computer keyboard and can't make fists. I suspect my grandfather may have had gout.
I never had any RA factors show up in my blood – so that was ruled out.
Your right about the blood level uric acid – mine has never been above 6. Strange….
Thanks for the reply and the information on the site. I really appreciate it.
THose numbers are very interesting John, <I've only seen your first post…the last is awaiting approval.> Nobody else has been watching excretion so closely.
What is clearly indicates that excretion of uric acid is very dependent on the concentration in the blood. My rule of thumb is that without intervention, excretion maxxes out at near 3/4 grams/day and that's precisely what you showed before treatment. Life would be so simple if that max rate would continue as we lower our uric acid production but as you see, it drops proportionally as uloric does its work (I've edited that last sentence becasue I misread your 17.8 as SUA rather than uriniary UA…sorry for any confusion)
Perhaps that is the single best argument for the most extreme treatment: combining probenecid with allopurinoll or febuxostat.
Concentration of urine uric acid is only of passsing interest and useful only to avoid forming kidney stones with a high concentration of urate and an acidic urine.
I know that if the blood level is below 6, the crystals start to dissolve. Does the same apply to the urine levels (UAU) ?
I think the correct assessment is that at a uric acid of 6.0 you will cease to deposit NEW crystals. How much dissolves is open to serious debate…I have had small tophi persist for YEARS and YEARS in spite off constant SUA below 5.0 (with 400 mg. allopurinol.) So once an attack subsides we might very well view the crystals as somewhat “walled off” and semi-permanent.
But I think it DOES apply to kidney stones that are not walled off and thus will dissolve in a alkaline medium that is low in urate…but urate stones seem to be of less concern these days than joint “stones”.
I agree with zip2play's assessment that your continuing discomfort is most likely to be from existing uric acid deposits. I think you are correct with “My hope is that all the pain now is really gain because the stuff is dissolving.”
I'm encouraged by your current blood uric acid results. You will probably need a few more weeks to clear the old crystals, and some, as in zip2play's experience, may remain long after they cease to cause pain.
Urinary uric acid is interesting. I've only had time to look in-depth at one study (Intermittent elevation of serum urate and 24-hour urinary uric acid excretion — Yu et al.), but that has some interesting data, and references to similar studies.
Most analysis is done on 24-hour excretion rates, as this is the best indication of how good your kidneys are from a gout point of view. Your first reading appears to be above normal, but Yu points out that there are large changes from day-to-day and argues for an upper normal limit of 1000. My interpretation of your clearance results is that the first test showed you were capable of normal uric acid excretion – i.e. an overproducer rather than underexcreter, and therefore a good candidate for allopurinol or febuxostat. Your later results are lower, I believe, because you are now producing much less uric acid thanks to the febuxostat.
The concentration of urinary uric acid is a much wider range than for blood. Our bodies have many control systems for blood to maintain temperature, pH level etc, but urine can vary enormously. Yu cites a normal range between 16 and 100 mg/dL, so your first result was normal, and your later ones again support the view that febuxostat is doing it's job. I can only assume that with these numbers, your risk for urate stones in the kidneys is very low. However, I'm only basing this on a very small amount of research, so the general advice of plenty of fluids and alkaline urine still applies.
Thank you, John, for your fascinating question and interesting facts. Now do me a favor, and login before your next post so that others can see your great contribution without waiting for admin approval
Yu cites a normal range between 16 and 100 mg/dL.
YOI, can anything approaching 100 mg./dL come out as anything besides solid chunks of urate?
John, you are the first person to report the ear tophi. I searched my ears regularly and several years ago found only ONE that might have been questionable…about half the size of a bb…but it went away after a week or so…or I scratched it off without thinking.
I guess with the ear tophi and the confirmed crystals in your synovial fluid there is zero doubt about your diagnosis.
What is your Uloric costing you?
zip2play said:
Yu cites a normal range between 16 and 100 mg/dL.
YOI, can anything approaching 100 mg./dL come out as anything besides solid chunks of urate?
I'm still very much the learner on this topic, and today I learned from “Solubility of uric acid and supersaturation of monosodium urate: why is uric acid so highly soluble in urine?” (Journal of Urology):
the increasing solubility of uric acid with the rise in pH depended solely on the increase of urate anion. As much as 220 mg./dl. of uric acid could be dissolved for 24 hours at pH 7.0. But following seven-day incubation the total dissolved urate concentration decreased to 16 mg./dl. due to NaU crystallization. The stability of NaU supersaturation depended not only on the concentration of sodium and urate anion but also on time and pH
220??!! are they taking the piss?
Apparently the ability to supersaturate uric acid is almost limitless…unless there is a single precipitating crystal…then WHAM. THe way kidneys work the stuff passes osmotically molecule by molecule which is the ideal way to achieve supersaturation.
But still, 220 mg./dL sounds like they'd have to scoop the urine out with a very tiny spoon.
It seems almost akin to supersaturating a sugar solution for anyone who has tried to make candy or caramel…you cannot leave a single crystal unmelted or you get instant recrystallization of the whole mess.
Good points. And I fear we are wandering way off topic now, but looking at uric acid from the urine point of view seems very different, and I'm fascinated to learn more.
These large values, especially the 220, are very much of the test tube than in vivo healthy humans. However, they do emphasize the importance of pH when considering the kidney and beyond.
To maximize uric acid clearance, the practical implications of the effect of pH on solubility underline the importance of alkalizing the urine. Flushing through with plenty of fluids should ensure the dreaded supersaturation disaster never gets near.
This is also making me think about blood uric acid. I know that our bodies keep blood pH very tightly controlled between 7.35 and 7.45. A very narrow range, but it is a logarithmic scale, so the difference could be significant. Now, I somehow need to find the solubility of uric acid at the extremes of this range at normal blood temperatures.
Anybody know where to look?
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