Chronic kidney disease (CKD) is often
characterized with slightly raised serum
uric acid levels. Earlier, this urate level was thought to be an innocent
biochemical marker of kidney dysfunction. But now, urate levels are said to be
a direct contributor to kidney damage via its role in glomerular injury,
tubular fibrosis, and glomerular hypertension.

There are several extraneous factors,
dietary or otherwise, leading to a surreptitious rise in serum urate levels.
This case study here describes one such dietary factor that is soft drinks. Soft
drinks are very popular nonalcoholic beverages across all age groups in India.
Market studies have shown exponential growth in the soft drink market all over
the country over the last 5 years.

The case study that I am mentioning here is
of an 80-year-old man, a known case of Chronic kidney disease, who presented
with sudden onset of right ankle pain and swelling. The kidney disease diagnosis
was made which was found to have been caused by obstructive uropathy secondary
to prolonged urethral stricture. His serum creatinine had remained stable over
the last 6 months along with normal blood biochemistry and he was only on oral
medications with no history of hemodialysis.

The clinicians were at first baffled by
this sudden enigmatic rise of urate levels. On further probing, it was revealed
that during the ongoing heat wave, the patient was feeling very thirsty. Since
his daily water intake was tightly regulated, he had started taking a popular
brand of cold drinks occasionally instead of water to quench his thirst. This
change in diet had occurred from the beginning of summer over the last 1 month.

The patient was advised to stop all cold
drink consumption immediately. He was also started on febuxostat 80 mg daily.
His uric acid levels came down to 5.8 after 3 weeks. The ankle pain subsided.
His serum creatinine also came down to previous levels.

So it was said that these soft drinks
contain a lot of harmful ingredients including, but not limited to, fructose.
Fructose is the only carbohydrate which increases blood uric acid levels, in
addition to increasing blood sugar levels. Usually, this rise is
asymptomatic and the levels come down with cessation of fructose intake. But in
cases like these, this sudden rise may precipitate an acute arthritis attack.
Thus, in CKD cases, it is advisable to avoid all these soft drinks completely.

In our country, there are a lot of
misconceptions about the dietary restrictions in gout, they often tend to gloss
over potentially harmful food like soft drinks. Thus, public awareness about
the health effect of soft drinks must be raised. Cases like this are more
likely to occur during the summer months in India.

Reference:

Rudrajit Paul1 , Rathindranath
Sarkar; Sudden Rise of Uric Acid Levels
in a Patient with Chronic Kidney Disease: Is a Common Food to Blame? J Assoc
Physicians India 2022;70(11).

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