High Uric Acid in a Blood Test: What Does It Mean?

High uric acid in a blood test means there is more urate in the blood than the laboratory's reference range. It is a risk factor for gout and kidney stones, but it is not a diagnosis on its own. MedlinePlus notes that many people have high uric acid levels without having health problems.

Uric acid forms when the body breaks down purines, which come from the body's own cells and from some foods. It normally leaves the body in urine. Levels rise when the body makes too much or the kidneys remove too little. This guide is for adults reviewing a result. It cannot interpret your number or decide whether you need treatment.

No single 'normal' number applies everywhere. Laboratories set their own reference ranges and units, so compare your result with the range printed on your report. The American College of Rheumatology (ACR) 2020 gout guideline defines asymptomatic hyperuricaemia as a serum urate of 6.8 mg/dL or more with no previous gout flares or tophi (lumps of urate under the skin).

One result is a snapshot. Your clinician will usually look at the trend, kidney function and the reason the test was ordered before deciding what it means for you.

A blood result alone is rarely urgent, but some symptoms are. The NHS advises getting an urgent GP appointment or calling NHS 111 if you have sudden joint pain and swelling and the pain is getting worse, you have a very high temperature or feel hot, cold or shivery, or you feel sick or cannot eat. These can be signs of an infection inside the joint.

For possible kidney stones, the NHS advises urgent help for severe pain, or a high temperature with chills or shivering. Pain usually starts in the side or lower back and can spread to the groin. Use local emergency services if symptoms are severe or you feel very unwell.

Gout happens when urate builds up over time and forms needle-shaped crystals in and around joints, causing sudden pain and swelling. The NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) states that many people with high serum urate will not develop gout. The ACR guideline cites observational data that only about 20% of people with levels above 9 mg/dL developed gout within five years.

For this reason the ACR 2020 guideline conditionally recommends against starting uric acid-lowering medicine for people with high uric acid and no prior gout flares or tophi. The panel felt that, for most such people, the benefits would not outweigh the costs and risks. Your own clinician may weigh your situation differently.

NIAMS and the NHS list several factors linked with higher urate or gout risk. Not all of them can be changed, and none proves the cause in one person.

• Diet: purine-rich foods, mostly from animal sources such as red meat, organ meats and some seafood, plus sugar-sweetened drinks.
• Alcohol: drinking alcohol raises risk and can trigger gout flares.
• Medicines: NIAMS lists diuretics (water tablets), low-dose aspirin, high doses of niacin and cyclosporine. The NHS also mentions some blood pressure medicines.
• Other factors: family history, being male, older age, menopause, obesity, high blood pressure, metabolic syndrome and chronic kidney disease.
• Cell breakdown: MedlinePlus notes that some cancers and cancer treatments can cause levels to rise.

Do not stop or change a prescribed medicine yourself. MedlinePlus advises talking to your provider before stopping any medicine. Diuretics and other medicines are usually prescribed for important reasons, such as blood pressure or fluid control, and stopping them can cause harm.

For people who already have gout, the ACR guideline conditionally recommends switching a thiazide-type diuretic to another blood pressure medicine when feasible. It also stresses that a change should only be made when the likely benefit outweighs the risks. It specifically recommended against stopping low-dose aspirin taken for an appropriate reason. These are decisions for you and your prescriber together. If a diuretic has also affected other blood results, see our guide on diuretics and low sodium.

MedlinePlus and NIAMS both note that high uric acid can contribute to kidney stones. A 24-hour urine uric acid test may be used to check whether uric acid is contributing to stones, or to track stone risk in people with gout.

Kidney stone symptoms can include pain in the side, back, lower abdomen or groin, fever or chills, feeling sick, needing to urinate often and cloudy urine. Small stones often cause no symptoms. If a stone has already been found, see our guide on a 4mm kidney stone for what usually happens next.

Treatment decisions usually depend on whether gout has developed. The NHS says people with frequent gout attacks or high uric acid levels may be offered uric acid-lowering medicine, and that it should be taken regularly even when symptoms settle. The ACR guideline recommends treatment for people with gout who have frequent flares, tophi or joint damage on imaging. After a first flare it conditionally recommends treatment for those with moderate-to-severe chronic kidney disease, a serum urate above 9 mg/dL, or kidney stones.

When treatment is used, the ACR recommends aiming for a serum urate below 6 mg/dL. Lifestyle steps from the ACR patient page include limiting alcohol, especially beer, cutting down on sugary drinks and purine-rich foods, and keeping a healthy weight. Talk to your clinician before making major diet changes.

Bring the full report with the result, units and reference range. These questions can help you understand the plan.

• Why was uric acid tested, and how high is my result compared with the lab's range?
• Could any of my medicines, alcohol use or diet explain it? Should anything change, and who decides?
• Do my kidney function and other results matter here?
• Am I at higher risk of gout or kidney stones, and what symptoms should I watch for?
• Is treatment worth considering for me, or is monitoring enough? When should it be rechecked?

On SameCase, patients and verified doctors share de-identified cases. Seeing how others with a high uric acid result, with or without gout, discussed medicines, diet and follow-up can help you prepare focused questions. Other people's results cannot predict yours, and we do not offer diagnoses or treatment advice.