UpH and Gout

Urine pH plays a significant role in gout and uric acid management.

SUMMARY	COMMENTS	Publication / Link
Acidic urine (low pH) is associated with increased risk of gout complications, while alkaline urine facilitates better uric acid excretion.		Uric Acid Stone Prevention What you can do https://theprostateclinic.com.au/wp-content/uploads/2016/02/uric_acid_stones.pdf
Urine pH and Uric Acid Excretion	Uric acid solubility in urine is highly dependent on pH. At a neutral pH of 7, urine can dissolve approximately 1,000 times more uric acid than at an acidic pH of 5[2]. This relationship is linear - as urine pH increases, so does uric acid excretion. Studies show that uric acid excretion increases from about 302 mg/day at pH 5.9 to 413 mg/day at pH 6.5[4][6]. The mechanism behind this involves the urate/OH- exchanger in the proximal tubule cells of the kidneys. In alkaline urine, a larger proportion of uric acid exists in its transportable conjugate base form (pKa = 5.35), making it easier to excrete[4].	Urine alkalization facilitates uric acid excretion - PubMed Central https://pmc.ncbi.nlm.nih.gov/articles/PMC2976726/
Acidic Urine and Gout Complications	Approximately half of gout patients have acidic urine pH[1]. This acidic environment creates several problems: 1. **Increased risk of nephrolithiasis (kidney stones)** - Urine pH < 5.0 is significantly associated with kidney stone formation[1] 2. **Higher prevalence of renal cysts**[1] 3. **Greater incidence of microhematuria (blood in urine)**[1] 4. **More proteinuria (protein in urine)**[1] Research indicates that patients with urine pH between 6.2 and 6.9 and serum urate ≤ 480 μmol/L had the highest eGFR (estimated glomerular filtration rate) with the lowest prevalence of kidney complications[1].	Association of acidic urine pH with impaired renal function in primary ... https://pubmed.ncbi.nlm.nih.gov/35078513/
Dietary Influence on Urine pH	Diet significantly affects urine pH: - **Acid-producing foods**: High-protein diets, especially those rich in animal proteins and meat, produce more acidic urine[4][6] - **Alkaline-producing foods**: Diets rich in vegetables and fruits produce more alkaline urine[3][4] This helps explain the long-standing observation that gout is more common among people whose diets are rich in meat and low in vegetables and fruits[6]. The sulfur-containing amino acids abundant in animal proteins are major determinants of urine acidity[4].	Urine alkalization facilitates uric acid excretion | springermedizin.de https://www.springermedizin.de/urine-alkalization-facilitates-uric-acid-excretion/25654820
Practical Implications	For gout management, maintaining a more alkaline urine pH appears beneficial: 1. **Dietary modifications**: Eating less animal protein and more vegetables and fruits can help make urine less acidic[3] 2. **Hydration**: Drinking adequate water prevents dehydration, which can concentrate uric acid in the blood[5] 3. **Medication**: Some healthcare providers may recommend urinary alkalinization in selected gout patients with acidic urine pH[1]	Gout Symptoms, Causes, Treatments, and Kidney Disease https://www.kidney.org/kidney-health/gout-and-kidney-disease Hyperuricemia (High Uric Acid Level): Symptoms, Causes & Treatment https://my.clevelandclinic.org/health/diseases/17808-hyperuricemia-high-uric-acid-level Effect of Urine pH on Uric Acid Excretion by Manipulating Food ... https://www.tandfonline.com/doi/full/10.1080/15257770.2011.596498 Uric Acid (Urine) | University Hospitals https://www.uhhospitals.org/health-information/health-and-wellness-library/article/lab-tests-v1/uric-acid-urine Uric acid urine test Information | Mount Sinai - New York https://www.mountsinai.org/health-library/tests/uric-acid-urine-test