Uric Acid (Serum) Test
The serum uric acid test measures urate, the end product of purine metabolism, and is the principal biochemical measure for assessing hyperuricaemia and gout. It guides and monitors urate-lowering therapy against defined targets and contributes to metabolic and cardiovascular risk assessment.
1
Biomarkers
Blood (serum)
Sample
1–3 business days
Turnaround
No — though some protocols prefer a fasting morning sample to limit dietary and diurnal variation
Fasting
What is the Uric Acid test?
The Uric Acid Test measures serum urate, the end product of purine metabolism, providing the central biochemical index for assessing hyperuricaemia and gout. It is used to evaluate patients with acute or recurrent inflammatory arthritis suggestive of gout, to investigate urate kidney stones, and to guide and monitor urate-lowering therapy. Within the assessment of crystal arthropathy and metabolic risk, serum uric acid is a necessary but not sufficient measure: definitive gout diagnosis rests on identifying monosodium urate crystals, and uric acid can be normal during an acute flare. The test nonetheless guides treatment targets, supports monitoring of urate-lowering drugs against a defined goal, and contributes to cardiometabolic risk assessment given the associations between hyperuricaemia, metabolic syndrome, hypertension, and renal disease. It is also central to anticipating and managing tumour lysis syndrome during cytotoxic therapy.
What does the Uric Acid test measure?
Uric acid is the terminal product of purine metabolism in humans, formed from the breakdown of endogenous and dietary purines via xanthine oxidase. Humans lack uricase and therefore cannot degrade it further, so circulating levels depend on the balance between production and renal excretion, with roughly two-thirds eliminated by the kidneys and the remainder via the gut. At physiological pH most uric acid exists as urate; above its solubility threshold it can crystallise as monosodium urate in joints and soft tissue. It also has antioxidant properties in plasma.
Serum uric acid is the principal biochemical measure in the assessment of gout and hyperuricaemia, and is used to investigate urate nephrolithiasis and to monitor urate-lowering therapy. Elevated levels are associated with metabolic syndrome, hypertension, and cardiovascular and renal risk, though hyperuricaemia alone is not diagnostic of gout. It is also monitored in tumour lysis syndrome and during cytotoxic therapy, where rapid cell turnover raises urate sharply.
Why is the Uric Acid test ordered?
- Assessment of suspected gout or recurrent inflammatory arthritis, recognising that urate may be normal during an acute flare and is interpreted alongside clinical and crystal findings
- Initiation and monitoring of urate-lowering therapy against a defined target (typically <6.0 mg/dL, or <5.0 mg/dL with tophi)
- Investigation of urate nephrolithiasis or recurrent uric-acid kidney stones
- Evaluation of hyperuricaemia identified incidentally or as part of a metabolic and cardiovascular risk profile
- Anticipation and monitoring of tumour lysis syndrome before and during cytotoxic chemotherapy for high-turnover malignancies
- Assessment of suspected secondary hyperuricaemia from diuretics, renal impairment, or high purine intake
- Investigation of hypouricaemia where a low urate may indicate renal urate wasting or rare metabolic conditions
Sample collection and turnaround
Sample type
Blood (serum)
Fasting required
No — though some protocols prefer a fasting morning sample to limit dietary and diurnal variation
Collection method
Venipuncture at patient service centre
Turnaround
1–3 business days
Collection notes
Document diuretic and other relevant medication use, recent alcohol or high-purine intake, and whether the patient is in an acute gout flare. For baseline assessment in gout, measure between attacks rather than during a flare.
Specimen requirements
Minimum 0.5 mL serum. Separate serum from cells per Access Medical Laboratories protocol. Specimen stable refrigerated; follow Access Medical Laboratories transport guidelines.
What can affect Uric Acid results?
Diuretics reduce renal urate excretion, raising serum uric acid and potentially precipitating gout. Diuretic use should be documented when interpreting an elevated result.
Serum uric acid frequently falls during an acute attack as urate deposits in the inflamed joint, so a normal level during a flare does not exclude gout. Re-measurement once the flare settles is more reliable.
Because the kidneys clear most uric acid, reduced glomerular filtration raises serum urate independent of production, a common cause of secondary hyperuricaemia.
Diets rich in red meat, seafood, and fructose, together with alcohol — especially beer — increase urate production and reduce excretion, raising serum levels.
Massive release of intracellular purines during cell lysis sharply raises uric acid, risking acute urate nephropathy; levels are monitored closely during cytotoxic therapy.
Low-dose aspirin reduces urate excretion and can raise levels, while some agents (e.g. high-dose salicylates, losartan) are uricosuric and lower them. Medication review is needed for accurate interpretation.
What do Uric Acid results mean?
Elevated
Hyperuricaemia may reflect reduced renal excretion (renal impairment, diuretics), increased production (high purine intake, alcohol, cell turnover), or a combination. It supports but does not confirm gout, and asymptomatic hyperuricaemia is common. Markedly elevated levels during chemotherapy raise concern for tumour lysis syndrome.
Normal
A normal serum uric acid does not exclude gout, particularly when measured during an acute flare when levels often fall. Repeat measurement between attacks gives a more reliable assessment of baseline urate.
Reduced
Hypouricaemia is uncommon and usually benign, arising from renal urate wasting, uricosuric drugs, or rare inherited conditions. Very low levels occasionally accompany SIADH or specific metabolic disorders.
Note: Uric acid alone does not diagnose gout — crystal identification remains definitive — and it can be normal during an acute attack. Levels are strongly influenced by renal function, diet, alcohol, and medications, so interpretation requires the clinical and pharmacological context. In urate-lowering therapy, the value is read against a therapeutic target rather than the population reference range.
Frequently asked questions
No. Serum uric acid often falls during an acute gout flare as urate deposits in the inflamed joint, so a normal level during an attack does not exclude gout. Measurement between attacks gives a more reliable baseline.
How to access the Uric Acid test
The Uric Acid reference page is free and open to all practitioners. Create a free practitioner account to see pricing, save tests to your list, and generate requisition forms. Verification takes 1–2 business days.
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Published: June 2, 2026
Last reviewed: June 2, 2026
- FitzGerald JD, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res. (2020)
- Richette P, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. (2017)
- Dalbeth N, et al. Gout. Lancet. (2016)
- Feig DI, et al. Uric acid and cardiovascular risk. N Engl J Med. (2008)
This content is for licensed healthcare practitioners only and does not constitute medical advice. Clinical decisions should be based on the full clinical picture and not on any single test result.
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