Uric acid (urate)

Pick Ordered or Not ordered to see the note.

Indicated when

• —Suspected gout, to support the diagnosis alongside clinical features such as joint pain, redness, and swelling, ideally with joint fluid analysis where feasible (see the gout tool for the full diagnostic approach)
• —Assessing risk for tumour lysis syndrome before or during treatment for a high cell-turnover malignancy
• —Recurrent uric acid kidney stones

Not indicated when

• —Routine annual or 'wellness panel' screening for uric acid in an asymptomatic adult with no joint symptoms, kidney stone history, or tumour lysis risk [6]
• —Starting urate-lowering therapy based on an incidentally high uric acid level alone, without a clinical diagnosis of gout: the 2020 ACR gout guideline's strong recommendations for starting urate-lowering therapy are scoped to tophaceous gout, radiographic damage due to gout, or frequent gout flares, not an isolated lab value [5]

Why not

Asymptomatic hyperuricemia (a high uric acid level with no gout symptoms) is common in the general population and, by itself, does not reliably predict who will go on to develop gout; treating a lab number rather than a clinical diagnosis risks unnecessary medication exposure without a guideline basis for doing so in that situation [5].

Better first step

If gout is suspected, evaluate the joint directly through history, examination, and, where feasible, joint fluid analysis, rather than relying on an isolated uric acid level; see the gout tool for the full approach.

Typical ND rationale

An ND may check uric acid as part of a wellness panel, reasoning that it is inexpensive and could flag a risk for gout or kidney stones before either becomes symptomatic.

Ontario coverage & CONO orderability

OHIP status

insured

Uric acid/urate (L252) is listed by name in the 2026 Schedule of Benefits for Laboratory Services, insured when ordered by a physician, midwife, or NP who has clinically assessed the patient. ND-ordered testing is not insured and is billed privately (Reg. 552 s.22(1); SOB-LS 2026 preamble).

CONO orderable

Yes — CONO list #128, #167

CONO list item 128, blood: 'Uric Acid (Urate)'; item 167, urine: 'Uric acid (urate).'

Linked conditions

• gout ↗

Counselling script

“If you're having joint pain that could be gout, checking uric acid alongside an exam makes sense, and I'll order that today. On its own, without joint symptoms, a high uric acid level doesn't reliably predict future gout, so I don't check it as routine yearly screening or treat it as a number by itself. If joint pain, redness, or swelling comes up in the future, let's revisit this together.”

Revisit if

• —New joint pain, redness, or swelling suggestive of gout
• —Recurrent kidney stones
• —Starting treatment for a malignancy with tumour lysis risk

References

1. [1]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkUric acid/urate (L252) is listed by name in the 2026 OHIP Schedule of Benefits for Laboratory Services
2. [2]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkCommunity lab tests are insured only when ordered under the Schedule by an authorized prescriber
3. [3]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
4. [4]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services
5. [5]American College of Rheumatology (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. linkStrong recommendations for starting urate-lowering therapy are scoped to tophaceous gout, radiographic damage due to gout, or frequent gout flares
6. [6]College of Family Physicians of Canada / Choosing Wisely Canada (2026). Family Medicine: Fifteen Tests and Treatments to Question. linkDon't do annual screening blood tests unless directly indicated by the patient's risk profile