Uric acid

Question

Dear ladies and gentlemen,
I have an increase of the uric acid for sometime. Are there any general recommendations for CF, at what amount of the uric acid this should be treated and which drugs can be used?
Is this also a typical finding in CF?
I have heard once, that the digestion enzymes (Kreon, Panzytrat etc.) contain a very high amount of purine.
Surely you can not allow yourself a low-purine diet in CF, because additionally you also have to pay attention that the weight is not decreasing rapidly…
Many thanks in advance.

Answer

Hello,
An increase of the uric acid is found frequently in CF-patients, especially in those, who take enzymes because of pancreatic insufficiency.
However, there are no special recommendations for CF-patients how and when to treat the increased uric acid level. The general recommendations for patients with a high uric acid-level /gout are the following:
The definition of an increased uric acid level is a blood-level > 6,4 mg/dl. Then a low-purine diet is advisable (e.g. low meat, no alcohol). In an episode of gout/ arthritis the acute therapy consists of nonsteriodal antiphlogistics or Colchizin. A chronic therapy with drugs is initiated in case of a) manifest gout (arthritis or nephrolithiasis), which according to my experience is very seldom in CF patients even with increased uric acid levels or
b) uric acid level > 9 mg/dl
The drugs of chocie are uricostatics (allopurinole, drugs which decrease the production of uric acid), uricosurics, which increase the excretion of uric acid are only the 2nd chocie.

The procedure of treating a high uric-acid level should be initiated in patients with or without CF according to the recommendations given above. The serum-level of uric-acid and the kídney-function (development of stones) should be monitored.

As in CF it could be a bit tricky to do a low-purine diet and a high energy diet together, we would advice to talk about your CF-dietian about that topic; then it should be no problem to work out a diet that is suitable to you as CF patient and as a patient with a high uric acid.

Yours sincerely,
Prof. Dr. Joachim Bargon

14.12.2007