Uric Acid in Severe Preeclampsia: A Narrative Review

Abstract

The diagnosis of preeclampsia is clinical, with systolic and diastolic blood pressure being the primary criteria. Clinical chemistry and urinalysis are the most essential tools the medical team has to assess the severity of preeclampsia. Uric acid is the first parameter of clinical biochemistry that is altered in the course of the disease. For many years, blood uric acid concentration has been a useful tool for the early clinical diagnosis of preeclampsia, differential diagnosis with chronic hypertension, gestational hypertension, and other mimicking conditions, and for initiating drug therapy. New-onset hyperuricemia is an important maternal parameter for decision-making regarding termination of pregnancy, prediction of maternal-fetal complications during pregnancy, postpartum complications, and maternal-fetal outcome. This narrative review addresses the most important data on uric acid biochemistry, its renal metabolism in normal subjects, and the physiological changes secondary to pregnancy. The main metabolic alterations identified in preeclampsia are reviewed. Normal blood uric acid concentration values are analyzed in healthy, non-pregnant women, values during normal pregnancy, and values in preeclampsia. The frequency of hyperuricemia and its correlation with preeclampsia severity are compared. This article also compares uric acid levels with serum creatinine and proteinuria, their clinical interpretation in severe preeclampsia, and their clinical utility as markers of renal function. It proposes adding uric acid measurement to the clinical laboratory tests used to assess maternal renal function. Research results support the triple role of Ua in preeclampsia: as an early biomarker of the disease, as a parameter of renal involvement, and as a potential therapeutic target in disease management. The narrative is intended for the medical community and healthcare professionals interested in the topic, who are not necessarily experts.