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After long term controversy regarding the causal role of high serum uric in different diseases that are commonly associated with high serum uric acid, the recent clinical , experimental, genetic and therapeutic trials have established an important role of high serum uric acid in causing these different diseases. The spectrum of diseases caused by hyperuricemia includes metabolic syndrome, diabetes mellitus, obesity, non-alcoholic fatty liver disease, hypertriglyceridemia, systemic hypertension, acute kidney injury, chronic kidney disease, kidney stone, toxemia of pregnancy, ischemic heart disease,heart failure and increased cardiovascular mortality. Treatment of high serum uric acid became a mandate to avoid development or progression of these diseases.