Hiperuricemia: el exceso de ácido úrico

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¿Qué es el ácido úrico?

El acido úrico es un producto de degradación de las proteínas. Se forma en las células del cuerpo durante los procesos metabólicos o están en los alimentos, principalmente carne y pescados.

En el organismo humano, el ácido úrico no tiene ninguna función natural. Al eliminarse se encuentra en la orina en pequeñas cantidades.

¿Cuál es el valor normal en nuestro cuerpo?

La concentración de ácido úrico en hombres es de 3.6 – 6.8 mg/dl para la mujeres de 2.5-6.8mg/dL, aunque se pueden encontrar niveles más bajos en los vegetarianos.

¿En qué momento se hace perjudicial el ácido úrico?

El ácido úrico generalmente, se disuelve en la sangre y después transita hacia los riñones, donde es desechado por medio de la orina. Si su producción es muy abundante, por ejemplo en un consumo excesivo de carne, entonces no se elimina completamente, acumulándose sobre todo en la inmediación del cartílago, y por lo tanto produciendo enfermedades molestas y dolorosas y presentándose altos niveles en la sangre, lo que se denomina hiperuricemia.

La saturación de ácido úrico en la sangre humana puede dar lugar a cálculos renales (nefrolitiasis) cuando el ácido cristaliza en el riñón.  Cuanto mayor es el aumento de ácido úrico en sangre mayores son las posibilidades de padecer afecciones renales, artríticas, etc.

¿Qué es la hiperuricemia?

Se considera ácido úrico elevado por encima de 7 mg/dl en mujeres y de 8 mg/dl en hombres.

La hiperuricemia es el principal factor de riesgo de gota, aunque la mayoría de los pacientes hiperuricémicos están asintomáticos y no la desarrollan.

Se habla de hiperuricemia crónica cuando se alcanzan niveles mantenidos de urato >6,8 mg/dl, nivel fisiológico de saturación del urato monosódico.

¿Cuáles son las principales causas de hiperuricemia?

La causa más común de hiperuricemia es una disminución del aclaramiento renal de ácido úrico. Otra causa común de hiperuricemia es la ingesta de medicamentos como los diuréticos, frecuente en personas de edad avanzada, y siempre debe sospecharse la posibilidad de insuficiencia renal que también es causa en hiperuricemia.

Solo en un pequeño porcentaje de pacientes que se estima inferior al 10%, la hiperuricemia resulta de un aumento de la producción intrínseca de ácido úrico, ya sea por algunos defectos enzimáticos infrecuentes o por aumento del catabolismo de purinas de origen interno en situaciones tales como anemias hemolíticas, policitemia vera, o acompañando a diversas neoplasias o a su tratamiento.

¿A quién afecta?

La hiperuricemia también es conocida como la enfermedad de los reyes, porque se relaciona con un buen nivel de vida, toda vez que el paciente ingiere alimentos ricos en purinas, como carnes rojas, leguminosas, vino o cerveza, que favorecen un ataque de gota.

Desde el punto de vista epidemiológico, tiene una prevalencia que oscila entre el 2.4 y 4.7 % en la población, principalmente masculina, entre los 20 y 50 años de edad. Las mujeres la presentan, pero con menor frecuencia, sobre todo cuando entran a la menopausia.

¿Qué síntomas presenta la hiperuricemia?

La mayoría de las veces el ácido úrico elevado no produce ningún síntoma.

En algunos casos el ácido úrico puede acumularse en las articulaciones y producir la gota o artritis gotosa. En otras ocasiones se acumula en el riñón y puede producir piedras (cálculos) o alterar su funcionamiento.

¿Cómo se detecta?

La hiperuricemia se detecta a través de un análisis de sangre donde encontremos valores de 7 mg/dl de ácido úrico en mujeres y de 8 mg/dl en hombres.

¿Existe tratamiento?

Sí existe tratamiento pero será escalonado.

La hiperuricemia en ausencia de gota o de litiasis renal se considera hiperuricemia asintomática y no requiere tratamiento, pero pese a ser asintomática es imprescindible seguir una serie de medidas higiénico dietéticas:

  • Se debe evitar el ayuno prolongado.
  • Es conveniente mantener un peso adecuado.
  • Es muy importante beber abundante agua (más de 2 litros por día).
  • Se debe evitar el alcohol en todas sus formas.
  • Disminuir la ingesta de alimentos ricos en purinas.

Posteriormente o simultáneo a las medidas higiénico dietéticas nuestro médico puede iniciar el tratamiento farmacológico.

¿En qué consiste el tratamiento farmacológico?

El objetivo es conseguir que los niveles de urato en plasma estén por debajo de 6 mg/dl, para que se disuelvan los cristales y no se depositen nuevos cristales en las articulaciones.

En caso de que la hiperuricemia sea asintomática no se debe comenzar tratamiento hipouricemiante; sólo en caso de que nuestro médico haya detectado excreciones de ácido úrico en la orina superiores a las normales, haya habido crisis gotosas o cólicos nefríticos, procederá a instaurar tratamiento.

¿Cómo y durante cuánto tiempo debo tomarlo?

Se inician no antes de 3 semanas después de una crisis de gota. Durante los 6 primeros meses de tratamiento hipouricemiante, y para evitar crisis gotosas, se recomienda realizar profilaxis de gota con colchicina o AINE.  Por lo general se trata con alopurinol durante períodos prolongados de tiempo (años). Si lo suspende bruscamente puede sufrir una crisis de ácido úrico. No se automedique.

¿Qué puedo hacer para prevenir la hiperuricemia?

  • No consuma alcohol o hágalo con moderación. Evite la cerveza. Las bebidas alcohólicas pueden desencadenar un ataque de gota.
  • Beba abundante agua, más de 2-3 l diarios, para evitar los cálculos renales. Las aguas alcalinas (bicarbonatadas) facilitan la eliminación del ácido úrico por la orina y reducen la formación de cálculos renales.
  • Modere el consumo de los alimentos ricos en ácido úrico como vísceras (hígado, sesos, criadillas, riñones), mariscos, pescado azul (anchoas, sardinas, arenques), embutidos y carnes rojas o de caza. Enlace tabla
  • Evite el sobrepeso. Si ha de perder peso, no haga dietas muy estrictas. Disminuya el consumo de grasas. Evite el ayuno prolongado.

Puede descargar en este enlace una hoja de recomendaciones dietéticas para los pacientes con niveles elevados de ácido úrico en sangre.

Si sabe que tiene el ácido úrico elevado, cuando vaya a tomar medicamentos nuevos dígaselo a su médico. Se debe tener en cuenta también el efecto en la uricemia de otros fármacos, entre los que destacan los diuréticos (sobre todo las tiazidas y los diuréticos de asa) y los salicilatos a dosis bajas.


María Hernández Carrasco
Médico adjunto, MFyC, Centro de Salud Arturo Eyries

REFERENCIAS:

  • Cruz Niesvaara D, Leiva Aranda I, Ibero Villa JL, Blanco López B. Revisión y actualización de la hiperuricemia (Ver) Sociedad Española de Medicos Generales y de Familia. Med Gen y Fam 2006; 88:593-602.
  • Montané i Esteva E. Manejo farmacológico de la hiperuricemia. (Ver) Butlletí dìnformació terapèutica 2009; 21(1):1-6.
  • https://www.fisterra.com/Salud/2dietas/pdf/hiperuricemia.pdf

Revisado: julio 2020

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