Hypouricemia (Renal Hypouricemia)
What is Hypouricemia (Renal Hypouricemia)?
Hypouricemia is a condition where you have abnormally low levels of uric acid in your blood. Uric acid is a waste product that your body makes when it breaks down purines, which are compounds found in many foods and in your cells. Normally, your kidneys filter out uric acid and release it through urine.
Renal hypouricemia happens when your kidneys remove too much uric acid from your blood. This occurs because of genetic changes in the proteins that transport uric acid in your kidneys. The most common mutations affect proteins called URAT1 and GLUT9, which normally help your body hold onto the right amount of uric acid.
Most people with this condition have no symptoms during daily life. However, the low uric acid levels can cause serious kidney problems during intense exercise. Understanding your uric acid levels helps you take steps to protect your kidney health, especially if you are physically active.
Symptoms
Many people with hypouricemia have no symptoms at all. The condition is often discovered by accident during routine blood work. When symptoms do occur, they usually happen during or after intense physical activity.
- Exercise-induced acute kidney injury, which causes sudden kidney dysfunction after vigorous exercise
- Back pain or flank pain during or after exercise
- Dark or cola-colored urine after intense physical activity
- Nausea or vomiting after strenuous exercise
- Kidney stones in some cases
- Reduced urine output after exercise
Some people with renal hypouricemia remain symptom-free their entire lives. Others may experience kidney injury episodes only during extreme physical exertion or in hot weather.
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Causes and risk factors
Renal hypouricemia is caused by genetic mutations that affect how your kidneys handle uric acid. The most common mutations occur in the SLC22A12 gene, which controls the URAT1 protein, or the SLC2A9 gene, which controls the GLUT9 protein. These proteins normally reabsorb uric acid from your urine back into your blood. When they do not work properly, your kidneys excrete too much uric acid, leading to very low blood levels.
This condition is inherited in an autosomal recessive pattern, meaning you need to receive a mutated gene from both parents to develop it. It is more common in people of Japanese and Korean descent but can occur in any ethnic group. Certain medications can also lower uric acid levels, but that is different from the genetic form of renal hypouricemia. Risk factors include a family history of the condition and unexplained kidney problems after exercise.
How it's diagnosed
Hypouricemia is diagnosed through a simple blood test that measures uric acid levels. A uric acid level below 2 milligrams per deciliter is considered diagnostic for hypouricemia. Your doctor may order additional tests to determine if the low level is caused by genetic renal hypouricemia or other factors like medications or liver disease.
Rite Aid offers uric acid testing through our annual blood panel at Quest Diagnostics locations nationwide. If your uric acid is low, your doctor may recommend a urine test to measure how much uric acid your kidneys are excreting. Genetic testing can confirm which specific mutations you carry, though it is not always necessary for diagnosis and management.
Treatment options
- Stay well hydrated before, during, and after exercise to protect your kidneys
- Avoid extreme or prolonged intense exercise, especially in hot or humid conditions
- Warm up gradually before physical activity and cool down slowly afterward
- Monitor urine color and stop exercising if it becomes dark
- Eat a balanced diet without restricting purines, as dietary changes do not significantly affect renal hypouricemia
- Inform healthcare providers about your condition before starting new exercise programs
- Seek immediate medical care if you develop back pain, reduced urination, or dark urine after exercise
- Some doctors may recommend xanthine oxidase inhibitors like allopurinol to increase uric acid levels in people with recurrent kidney injury
Concerned about Hypouricemia (Renal Hypouricemia)? Get tested at Rite Aid.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
A uric acid level below 2 milligrams per deciliter is considered abnormally low and diagnostic for hypouricemia. Normal uric acid levels typically range from 3.5 to 7.2 milligrams per deciliter in adults. Levels between 2 and 3 milligrams per deciliter may warrant monitoring and further testing.
Most people with hypouricemia live normal, healthy lives without complications. The main risk is exercise-induced acute kidney injury, which can occur during intense physical activity. This kidney injury is usually reversible with prompt treatment and rest. Knowing you have the condition allows you to take preventive steps during exercise.
Yes, you can exercise with renal hypouricemia, but you should take precautions. Stay well hydrated, avoid extreme intensity, and warm up gradually. Stop immediately if you develop back pain or notice dark urine. Many people with this condition exercise safely by following these guidelines.
Renal hypouricemia is inherited in an autosomal recessive pattern. This means you must inherit a mutated gene from both parents to develop the condition. If both parents carry one copy of the mutation, each child has a 25 percent chance of having hypouricemia.
Stop exercising immediately and drink plenty of water. Dark or cola-colored urine after exercise can indicate rhabdomyolysis or acute kidney injury. Seek medical attention right away, especially if you also have back pain, nausea, or reduced urination. Early treatment can prevent serious kidney damage.
Yes, certain medications can lower uric acid levels, but this is different from genetic renal hypouricemia. Drugs like losartan, fenofibrate, and high-dose aspirin can reduce uric acid. Tell your doctor about all medications you take when discussing low uric acid results. Your doctor can determine if medication or genetics is the cause.
No, you do not need to follow a special diet for renal hypouricemia. Unlike high uric acid levels, low levels are not significantly affected by dietary purine intake. Focus on a balanced, nutritious diet and staying well hydrated. Your kidneys are excreting too much uric acid regardless of what you eat.
If you have diagnosed hypouricemia, annual testing is usually sufficient to monitor your levels. More frequent testing may be needed if you experience symptoms or if your doctor is adjusting treatment. Rite Aid offers convenient annual testing that includes uric acid measurement in our standard panel.
Yes, some people with renal hypouricemia develop kidney stones, though this is less common than exercise-induced kidney injury. The stones are usually made of uric acid or calcium. Staying well hydrated and monitoring your kidney health can help reduce stone risk. Report any symptoms of kidney stones to your doctor.
There is no cure for genetic renal hypouricemia because it is caused by permanent changes in your DNA. However, the condition can be managed effectively through lifestyle modifications and preventive care. Most people live full, active lives by staying hydrated and avoiding extreme exercise intensity. Some cases may benefit from medication to raise uric acid levels.