Clinical significance of hypouricemia in children and adolescents

Pediatr Nephrol. 2023 Sep;38(9):3017-3025. doi: 10.1007/s00467-023-05948-4. Epub 2023 Mar 31.


Background: Although hyperuricemia is a widely studied condition with well-known effects on the kidneys, hypouricemia is usually considered a biochemical abnormality of no clinical significance despite the fact that it can be a sign or major finding of serious metabolic or genetic diseases affecting kidney health. In this study, we aimed to investigate and emphasize the clinical significance of hypouricemia.

Methods: Patients were evaluated retrospectively for persistent hypouricemia defined as serum uric acid concentrations of < 2 mg/dL on at least 3 different occasions. According to the blood and urine uric acid (UA) levels, the patients were classified as having hypouricemia due to UA underproduction vs. overexcretion. Demographic, clinical, and genetic characteristics were noted for analysis.

Results: Fourteen patients (n = 14; M/F 8/6) with persistent hypouricemia were identified. Hypouricemia due to underproduction was the cause of 42.8% of these cases. All of the patients with a uric acid level of 0 mg/dL (n = 4) had hypouricemia due to underproduction. The median serum uric acid level was 0.85 (0-1.6) mg/dL. Isolated hypouricemia and hypouricemia with metabolic acidosis were equally distributed. Among the patients with hypouricemia due to underproduction, the final diagnoses were xanthine dehydrogenase deficiency (n = 5) and alkaptonuria (n = 1). In the overexcretion group, the final diagnoses were nephropathic cystinosis (n = 6), distal renal tubular acidosis (n = 1), and hereditary renal hypouricemia (n = 1). The diagnostic lag was longer for patients with isolated hypouricemia compared to other patients (p = 0.001).

Conclusions: Hypouricemia may reflect underlying genetic or metabolic diseases, early diagnosis of which could help preserve kidney function. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Hereditary renal hypouricemia; Hypouricemia; Uric acid; Xanthine dehydrogenase.

MeSH terms

  • Acidosis, Renal Tubular*
  • Adolescent
  • Azotemia*
  • Child
  • Humans
  • Metabolism, Inborn Errors*
  • Renal Tubular Transport, Inborn Errors* / diagnosis
  • Renal Tubular Transport, Inborn Errors* / genetics
  • Retrospective Studies
  • Uric Acid


  • Uric Acid