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Can gout appear on liver similar to liver fat?
Question: I am a 37 yr old male from England UK. I saw gastro consultant as original LFT reported high ALT and high bilirubin.4 months ago. On re-test recently ALT normal as were all other bloods, linked to LFT except bilirubin still at level 26 .Ultrasound however "appeared" to show fatty liver. I hardly ever drink, so not alcohol related. Consultant thinking NAFLD, which he says is reversable with more exercise and some weight loss. I am hardly over weight maybe a little stomach fat, but not excessive. I read in a recent study people with a high bilirubin level don't tend to suffer from liver fat, as bilirubin acts as an antioxident against it ? My concern is that what I forgot to mention to my consultant is that I suffer from gout, about one major attack a year, lasts about 4 days (for last 6 years) and have high uric acid levels. I take 600mil Ibuprofen when attack occurs, but not on permanent meds. Is it true gout can sometimes appear on liver similar in appearance to liver fat and it could be this rather than NAFLD ? Secondly, my father was diagnosed with sarcoidosis (not specific liver) when he was my current age. He only lived 3 years after diagnosis. I read sarcoid can appear on liver , & again look similar to liver fat. Is that true ? As someone who tends to get anxious, I am concerned that what may look like liver fat, could be one of these two things? Other than high bilirubin and ultrasound showing what looks like NAFLD, I have no other symptoms. My consultant has asked me to return in 2 months for repeat bloods. Note - Two minor things, I don't think they are related but I wake up most nights half way through with a really dry mouth, and need half a cup of water to get me through til morning., and whenever I get a common cold, if I have a cough, it always seems to take longer to clear up than most people, although always does in end.
Brief Answer: Please provide your test reports... Detailed Answer: Hi, I had gone through your query and understand your concerns. Before running into final conclusions, I gently ask to have the reports of your blood works and other tests you did uploaded. Those reports will help me assist you further. Although studies have their own conclusions, they cannot be a definite conclusion until further studies won't show the contrary. So far, we cannot admit that people with high bilirubin won't suffer of fatty liver. If I was your caring doctor would determine: - how high is your bilirubin (based on the reports you'll gently provide) - what is causing this high bilirubin and fatty liver? - what other conditions or diseases you might be suffering and see if they have correlation? Having NAFLD is caused by an auto-immune disorder, so, we must go in depth and find it out. Looking forward to have your reports to further assist you! Thank you! Dr.Klerida
Hi Original bloods that were abnormal 5 months ago - Albumin 52 (normal range 35-50) Total bilirubin 26 (normal less than 21) ALT 78 (normal 10-60) On retest 2 weeks later - Albumin 53 Bilirubin dropped to 19 ALT dropped to 60 EBV VCA IgG detected- recent (doctor asked if I ever had glandular fever, but I haven't.) Hepatitis A-C negative Latest results from last week - My doctor has them still , but talked me through them and said all normal except bilirubin high. Did not say exact level. ALT down to about 30. My uric acid was not checked, however I have a home checking meter, and that currently says 10.2 mg/dl. Normal range (3-7) 10 is about average whenever I have checked it. Have changed diet to low purine and trying to bring it down without permanent meds. I did have an acute gout attack about 5 weeks ago. Could that be what is thought to be liver fat, rather than liver fat itself ? Does uric acid get processed by the liver as well as kidneys, and the crystals show up like fat on the liver ?
Brief Answer: Gout have been associated with NAFLD... Detailed Answer: Hi and thank you for following up! Sorry for my late! With regards to your liver panels (ALT and bilirubin) is founded to be slightly elevated. This may be caused by fatty liver (NAFLD) which is a possible complication of the gout. Increased serum uric acid (gout) levels have been associated in the development of non-alcoholic fatty liver disease (NAFLD), especially in men presenting with metabolic syndrome. The uric acid liver deposits couldn’t be seen in abdominal ultrasound and it’s impossible for a trained doctor to misdiagnose NAFLD. Hope it answer to your queries! Wish you health! Dr. Klerida
Thanks you for your reply. What in your opinion should my doctor be looking for checking next ? If it is NAFLD due to uric acid levels, do you think this is reversable if I can get the uric acid lowered down ? How long does NAFLD take to return to normal liver ? What would you suggest to help lower uric acid levels ? I already looked at diet and trying to lose a little weight (I am not very much over weight though). I am also trying to do more exercise. Any other suggestions please ?
Brief Answer: Following answers to your query Detailed Answer: Hi, In your case, NAFLD might have been caused by high uricemia, however, there are other factors (like bad lifestyle-sedentary life, diet regimen; obesity) that could have also caused NAFLD. Regarding the time of returning the NAFLD to normal liver, no one can give an exact time because it all depends on: - how the uric acid will be reduced - if diet and lifestyle changes are working - how much your weight will be lowered With regards to lowering uric acid levels, diet and lifestyle changes do play the major role. The most common drug prescribed is allopurinol, but it all depends on how high the uric acid levels are. At the end, I would strongly suggest to continue the lifestyle and diet changes as you are doing now for the next 3 months. After this period, you can come back to me and report your changes. Dr.Klerida
Thank you for your replies. For my final question, I would like to mention the fact I have a home meter for checking my uric acid levels. Yesterday it was 9.2mg/dl When I woke up today, I checked the levels before I even got out of bed and it was 12mg/dl. Within an hour it had dropped three points to 9.7 mg/dl. I had not eaten or drank anything to make a sudden change. Does this sound normal that uric acid could change so quickly ? I am wondering if I should believe my home meter of not. I checked to ensure enough blood for the reading, and that seemed ok. If my high uric acid , is the cause of fatty liver, I am keen to understand why I personally have had high uric acid levels for 7 years, with a gout attack about once a year. I am nervous of just taking allopurinol to lower the uric acid by force. I feel if my body is producing that level of acid in the blood, it must be doing it for a reason. It is surely that reason that I need to understand, before going to permanent medication ? Would you agree ? My blood pressure is good and normal. This was checked recently, as I understood uric acid could cause cardio issues. I wonder if my body just produces high uric acid levels naturally for no reason, and that is the cause of fatty liver, or if both are the results of something else ? I really feel understanding this is the key, rather than just force the levels down through allopurinol, as that might mask the underlying reason ? What are your thoughts please ?
Brief Answer: Possible causes to high uric acid levels... Detailed Answer: Hi, It is true that uric acid levels can be different depending on the medications you are taking and how much uric acid is being eliminated in the urine. However, your uric acid levels variations were huge within a very short time. To my opinion, you should control if your uric acid meter is working properly and to change meter or have it measured in a professional lab. There are many factors that influences high uric acid levels. You can discuss with your doctor what causes high uricemia in you: - heredity (where your body is producing uric acid in excessiveness, while elimination or diet is within normal ranges) - kidney problems (elimination) - diet - drugs you might be taking I understand you are stressed out. Your current situation needs a deep analysis to find out the real culprit (cause). However, there is nothing you should be worried too much. I highly suggest to discuss with your doctor about the possible causes to your high uricemia. With regards to using allopurinol, it is a must especially in cases where high uric acid levels are caused due to heredity. In other cases, treating the underlying cause will help improve uric acid levels. Hope it was of help! Let me know if you have other concerns! Dr.Klerida
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