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Biomarker library / Metabolic

Uric acid (UA)

Also called serum urate, gout blood test

Uric acid (serum urate) is the end product of purine breakdown. When blood levels run high enough for long enough, urate crystals can form in joints, producing gout, and in the urinary tract, producing kidney stones.

Written by the VitalDecades editorial team Reviewed by the editorial review process Updated

01  /  Reference ranges

What counts as normal

Scale in mg/dL. Cut points from the sources listed below.

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Population Adults with gout on urate-lowering therapy
Category Treatment target
Range under 6 mg/dL ACR 2020: a treat-to-target strategy with serial urate measurements and a target under 6 mg/dL (strong recommendation).
Source 2020 American College of Rheumatology Guideline for the Management of Gout

Effective

Normal vs optimal

Lab reference ranges vary and differ by sex, and no guideline body publishes a universal normal range we can print, so we do not. The number with a published, load-bearing threshold is the treatment target for diagnosed gout: under 6 mg/dL.

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02  /  Why it matters

What the number tells you

For people with gout, the number is the treatment: the American College of Rheumatology 2020 guideline strongly recommends treating to a serum urate target below 6 mg/dL, with dose escalation and repeat measurement until the target holds. For a high level WITHOUT gout (asymptomatic hyperuricemia), the same guideline conditionally recommends against starting urate-lowering therapy: most people with high urate never develop gout, and the drugs are lifelong.

03  /  In practice

Testing and what moves it

When it is tested

  • With a suspected or confirmed gout flare (though levels can read deceptively normal mid-flare), for kidney stones, and to titrate urate-lowering therapy.
  • On therapy, the ACR guideline re-checks serum urate serially until it holds under 6 mg/dL.

What raises it

  • Purine-rich intake (organ meats, some seafood), beer and spirits, sugary drinks with fructose, dehydration.
  • Diuretics and low-dose aspirin, kidney disease, obesity and insulin resistance, genetics.

What lowers it

  • Allopurinol and other urate-lowering therapy (the reliable lever), weight loss, less alcohol and fructose, adequate hydration.

04  /  Related

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Frequently asked questions

What uric acid level causes gout?

Risk rises with the level, but there is no line that guarantees gout; many people with high urate never get it. That is why the ACR guideline treats diagnosed gout to under 6 mg/dL but conditionally recommends against medicating asymptomatic high levels.

My uric acid was normal during a gout attack. How?

Levels can dip during a flare, so a normal mid-flare value does not exclude gout. The steadier read is between flares, and diagnosis rests on the clinical picture or crystal identification, not the blood number alone.

Can diet alone get me under 6?

Diet moves urate modestly (roughly 1 mg/dL for substantial changes); people who need to get from 8 or 9 down below 6 usually need medication, with diet as the supporting act. That is the logic of the treat-to-target recommendation.