Uric Acid... Gout...Stone in Kidneys

 Understanding Uric Acid

 Uric acid is the end product of purine compound metabolisms. Its formation depends on the amount of purine from the food consumed and from the formation of purines in the body. Metabolism is a chemical process or chemical reaction that naturally always occurs in the body.

Uric acid is actually a normal part of blood and urine. Uric acid is produced from the breakdown and waste of waste products containing purine nucleotides or from purine nucleotides produced by the body. This means that naturally the human body will always have a limited amount of uric acid.

Uric acid comes from the word uric acid. The word uric means urine while acid means acid. So uricacid or uric acid is a condition in a person whose urine (urine) has acidic properties. High-density white urine that can settle. This white deposit is acidic which became known as uric acid. 

Gout or arthritis is known as gout disease. This disease has been known since ancient Greece, and the people dubbed it the disease of kings. Diseases commonly suffered by kings or wealthy groups of people. The word gout comes from the Latin word gutta or guttan which means drop. This disease is thought to arise due to the presence of poison drops in the joints.

urate crystals in tophus

Vein Crystals in Tophus

 has identified the presence of gout that occurs in the big toe. In the thirteenth century, Galen wrote about deposits of sodium urate (urate salts) found in the tissue under the skin called tophi. discovered crystals contained in tophi deposits. Tofi or tophus is a small white lump filled with uric acid.  

Formation of Vein Crystals

Joint disease caused by gout is a disease that occurs because of an increase in uric acid levels in the blood. The uric acid level in the body exceeds the threshold. The excess will be transferred by the blood to the body organs. It is in these organs of the body that uric acid can be deposited into urate crystals. These urate crystals are called monosodium urate monohydrate (MSUM). One of the organs in which these crystals are deposited is the joint organ,

About 75 percent of the first attacks of gout generally occur in the joint of the base of the big toe. However, gout can occur in the heels, ankles, knees, wrists, elbows and spine.

The body will identify these urate crystals as foreign. This causes immune cells to react against it. Resistance of these immune cells causes an inflammatory or inflammatory reaction.

he presence of urate crystals irritates the joints. Visually looks reddish swelling accompanied by pain. This arthritis disease is called arthritis. Because uric acid is a trigger for this disease, it is called arthritis gout.

Uric acid settles in the orthorombic system with several crystalline forms. Classic crystals are thin, rhombic shaped plates with a slightly eroded top. Other forms are hexagonal plates, needles and rosettes. Uric acid crystals usually have a characteristic yellow color.

The intensity of the color that appears depends on the thickness of the crystal. Crystals with very thin plates do not appear colored, while large crystals have a brownish color. Under polarized light, uric acid crystals show a fairly characteristic polarizing color.

tests carried out in the laboratory with the aim of knowing the uric acid levels in a person's body. There are 2 types of uric acid tests, namely blood and urine tests.

High blood uric acid levels can cause uric acid crystals in the joints, causing inflammation in the joints. Apart from blood, uric acid checks can also be done through urine.

Uric acid, which is produced by our body, is filtered by the kidneys and excreted in the urine. So that low uric acid levels in the urine can reflect poor kidney health. In addition, high uric acid in urine is also dangerous because uric acid can form crystals, causing kidney stones.

The uric acid test results are expressed in units of mg / dL or micromol / L. The results of uric acid illustrate the balance between the production and excretion of uric acid in the body.

The following are some of the functions of the uric acid test in blood and urine:

Measure the uric acid value (uric acid)

Diagnosing gout (gout)

Diagnosing the presence of kidney stones

Monitor uric acid values ​​in gout sufferers

Monitoring patients after chemotherapy

Measuring the ability of the kidneys to balance uric acid production and excretion

Uric Acid Examination Procedure

The following is the procedure for checking uric acid levels:

1. The process of taking blood samples

Patients who are going to undergo a uric acid test will need to pass a blood sampling procedure. A blood sample is drawn through a vein in the arm. Actually, uric acid testing does not require any specific preparation.

The side effect of the blood draw procedure is a bruise or hematoma at the injection site, which can disappear in about 3 days-5 days.

2. The process of taking urine samples

Uric acid examination is carried out by collecting urine samples for 24 hours using a sterile bag that has been provided from the laboratory.

3. Examination of blood and urine uric acid in the laboratory

The blood and urine samples that are already available will be given a label description. The next procedure in uric acid examination is measuring uric acid levels in blood and urine in the laboratory.

The measurement of uric acid values ​​can be done by two methods, namely the stick method and the enzymatic method. The stick method requires a Nesco Multicheck strip and tool. The principle of this stick method is the use of a catalyst together with biosensor technology to measure the concentration of uric acid.

The advantage of the stick method in the uric acid test is that it requires fewer blood samples. In addition, the time needed to get the uric acid value is relatively faster. In the enzymatic method, uric acid is broken down into allantoin and hydrogen peroxide.

Furthermore, the fraction results are given perosidase enzymes and other substances to form a red substance. The intensity of the red color of the newly formed substance is proportional to the concentration of uric acid.

Factors Affecting the Accuracy of Uric Acid Test Results

The results of examining uric acid levels in blood and urine are not always accurate. This is because there are several factors that affect the accuracy of the uric acid test results.

The following are the factors that affect the accuracy of the uric acid test results:

Pre-analytic stage

Patient identity

Preparation of the patient

Method of sampling

Sample type

Inspection tools and materials

Analytic stage

Skill level of laboratory analyst checking uric acid

Sample handling process

Method used

Post analytic stage

Result reading

Recording results

Reporting of results

Interpretation of results with patient identity

Uric Acid Normal Value

The normal value of uric acid, of course, must be known. This value will be used as a reference for the results of the uric acid test in the patient. The concentration of uric acid in the blood has different values ​​depending on the age and gender of the patient.

According to data obtained from the Centers for Disease Control and Prevention (CDC), the normal values ​​for uric acid in several age categories can be seen below:

Children 1-10 years: 1.9-5.4 mg / dL

Children aged 10-18 years: 3.5-7.3 mg / dL

Adult women: 2.9-7.5 mg / dL

Adult men: 3.6-8.4 mg / dL

The range of normal values ​​for uric acid is not the same in all laboratories. However, the difference between the numbers in the normal value is only slightly different.

If Uric Acid is High

A blood uric acid level that is higher than normal is also known as hyperuricemia. Hyperuricemia is caused by excessive uric acid production, decreased uric acid excretion, or a combination of the two. A high uric acid value should not be underestimated because it is an indication of some medical problem or other thing, namely:

1. Eat foods high in purines

Consumption of foods high in purines such as organ meats, liver, brain, beef, anchovies, sardines, nuts, tea and coffee can increase uric acid production so that levels of despair.

2. Gout

High uric acid levels can cause gout. Gout is characterized by inflammation of the joints, especially of the big toe. The most common symptom of gout is with severe pain in the joints, with the intensity of pain that is more severe in the morning or after exertion.

3. Kidney Disease

Some kidney diseases such as kidney stones and renal insufficiency result in decreased ability of the kidneys to filter and remove uric acid, resulting in high blood uric acid levels. The increase in uric acid can form crystals which can cause inflammation of the joints.

4. Chemotherapy

Patients who have cancer and undergo chemotherapy will experience an increase in uric acid production so that the uric acid value is high.

If Uric Acid is Low

A uric acid test in blood serum and urine can also show a value that is lower than the normal value of uric acid. . A low uric acid value indicates a number of medical problems, including:

1. Less consumption of foods containing purines

As explained above, uric acid is formed by breaking down purines. Therefore, foods that contain high purines will increase uric acid levels. Conversely, the lack of consumption of foods containing purines will result in low uric acid levels.

2. Wilson's disease

Wilson's disease is a genetic disease, in which the body cannot remove copper metal, causing a buildup of these substances and damage to liver cells. One sign of this disease is found low uric acid levels on blood tests.

3. Side effects of drugs

Some of the drugs that have been reported to cause low uric acid levels are probenecid, salicylates, estersogens and phenylbutazone.

Treatment of gout sufferers.has two main goal namely:

 treatment with short-term goals and treatment with long-term goals. The short-term goal is to reduce pain and relieve swelling. While the long-term goal is to stabilize the uric acid content in the blood.

Medicines that can be given for short-term purposes are drugs in the group of nonsteroidal anti-inflammatory drugs, NSAIDs such as indomestatin, naproxen, diclofenac sodium, celocoxib, and etodolac.

In the long term, drugs that function as xanthineoxidase inhibitors can be given, drugs that are in the IXO group, xanthine oxidiase inhibitors such as allopurinol or drugs that can increase uric acid excretion through urine, namely drugs in the uricosuric group such as probenecid and salicylates.

The dose or dose of the drug used must be adjusted to the type and severity of the disease being suffered, in order to get optimal function of the medicine. Basically medicine is poison. The medicine will poison the source of the disease, but in an incorrect dose, the drug is the source of the disease.

Because drugs have side effects or other effects beyond their function, they should always consult an expert. Several types of drugs can be purchased over the counter, but never take them if you do not have adequate knowledge about the drug and its effects.

NonSteroid Anti-Inflammatory Drugs, NSAIDs.

Drugs in the NSAID group function as painkillers to relieve or relieve pain. This type of drug also has an anti-inflammatory function that can reduce swelling in gout. Indomethacin is a drug from the NSAID type which is very effective in overcoming pain.

Only about two hours the pain can be reduced and gone. Besides being able to reduce pain, giving indomethacin drugs can prevent overreaction between inflammatory cells and uric acid.

One of the side effects of NSAID-type drugs is the depletion of the protective layer of the stomach (gastric mucosa), so that the stomach is easily irritated by stomach acid. The use of NSAID-type drugs is usually accompanied by drugs that can protect and prevent bleeding in the stomach.

Xanthine Oxidiase Inhibitor, IXO.

Drugs in the IXO group function as inhibitors of purine metabolisms to uric acid. This means that this drug will reduce uric acid formation. IXO drug administration is intended for the long term. So that the drug given the dosage gradually changes.

Starting with a small dose, then gradually increase it. This stage aims to avoid a sudden drop in uric acid levels in the blood. A drastic drop in uric acid levels will actually lead to acute gout attacks.

Allopurinol is a drug that acts as an inhibitor for uric acid formation. This drug is usually given at a dose of 50 - 300 mg per day. The side effects of using Allopurinol are mild allergies such as hives or severe allergies such as blisters on part of the body's skin.

Uricosuric Medicine.

Drugs in the uricosuric group function to increase uric acid excretion through urine. This means that the urine that is excreted will have a high uric acid content. So the more urine that is removed from the body, the more uric acid that comes out.

Provisions that must be considered from uricosuric drugs are that the sufferer must not be previously hyperexcreted. A person is said to be hyper-excreted if there is uric acid in the urine in excess of 1000 mg per day. Excessive uric acid discharge can lead to urate stone formation in the urinary tract.

Coffee Can Lower Uric Acid Levels

Several studies have been conducted on two groups, namely the group who drank coffee and the group who drank tea. The results showed that coffee and tea did not cause an increase in uric acid levels in the blood.

The group that consumed coffee as much as four to five cups per day, uric acid levels can drop by about five milligrams / deciliter. From research it is also known that caffeinated or uncaffeinated coffee has the same effect, which is both lowering uric acid levels in the blood.

the best time to drink coffee is after the hormone cortisol has passed its peak or after 9 o'clock in the morning. "In the morning, coffee is most effectively enjoyed between 9:30 a.m. and 11:30 a.m., when  cortisol levels drop before rising again. The reason is, if someone drinks coffee when the hormone is still high it can cause the body to increase tolerance to caffeine. This means that a person will need a larger amount of caffeine each morning to get the same effect. The same dose of coffee every morning becomes ineffective. This resistance is analogous to the consumption of drugs when sick. When the body takes drugs under normal conditions, the body will develop tolerance (resistance) to the drug. So the body asks for a larger dose to create the same effect. "This is because cortisol production is closely related to alertness," However, the cycle of cortisol levels in each person can be different. Someone who is accustomed to getting up earlier every day, may have a low cortisol cycle earlier than other people who wake up later.

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Dont 

consume some coffee with any drugs together