Sudden Rise of Uric Acid Levels in a Patient with Chronic Kidney Disease: Is a Common Food to Blame?

Chronic kidney disease (CKD) is often characterized with slightly raised serum uric acid levels. Earlier, this urate level was thought to be an innocent biochemical marker of kidney dysfunction. But now, urate levels are said to be a direct contributor to kidney damage via its role in glomerular injury, tubular fibrosis, and glomerular hypertension.

There are several extraneous factors, dietary or otherwise, leading to a surreptitious rise in serum urate levels. This case study here describes one such dietary factor that is soft drinks. Soft drinks are very popular nonalcoholic beverages across all age groups in India. Market studies have shown exponential growth in the soft drink market all over the country over the last 5 years.

The case study that I am mentioning here is of an 80-year-old man, a known case of Chronic kidney disease, who presented with sudden onset of right ankle pain and swelling. The kidney disease diagnosis was made which was found to have been caused by obstructive uropathy secondary to prolonged urethral stricture. His serum creatinine had remained stable over the last 6 months along with normal blood biochemistry and he was only on oral medications with no history of hemodialysis.

The clinicians were at first baffled by this sudden enigmatic rise of urate levels. On further probing, it was revealed that during the ongoing heat wave, the patient was feeling very thirsty. Since his daily water intake was tightly regulated, he had started taking a popular brand of cold drinks occasionally instead of water to quench his thirst. This change in diet had occurred from the beginning of summer over the last 1 month.

The patient was advised to stop all cold drink consumption immediately. He was also started on febuxostat 80 mg daily. His uric acid levels came down to 5.8 after 3 weeks. The ankle pain subsided. His serum creatinine also came down to previous levels.

So it was said that these soft drinks contain a lot of harmful ingredients including, but not limited to, fructose. Fructose is the only carbohydrate which increases blood uric acid levels, in addition to increasing blood sugar levels. Usually, this rise is asymptomatic and the levels come down with cessation of fructose intake. But in cases like these, this sudden rise may precipitate an acute arthritis attack. Thus, in CKD cases, it is advisable to avoid all these soft drinks completely.

In our country, there are a lot of misconceptions about the dietary restrictions in gout, they often tend to gloss over potentially harmful food like soft drinks. Thus, public awareness about the health effect of soft drinks must be raised. Cases like this are more likely to occur during the summer months in India.

Reference:

Rudrajit Paul1 , Rathindranath Sarkar; Sudden Rise of Uric Acid Levels in a Patient with Chronic Kidney Disease: Is a Common Food to Blame? J Assoc Physicians India 2022;70(11).