An abnormal level of uric acid could lead to serious diseases and complications, such as gout, as well as renal and cardiovascular diseases. Uric acid biosensors have been developed widely for clinical applications. This work covers the fundamentals and challenges for the development of such sensors. The topics include the sensing principles for detecting uric acid, the types of sensing signals and signal generation methods, the sensing electrode materials and configurations, the enzymatic and non-enzymatic uric acid sensors, the electrochemiluminescence sensors, the modification approaches for the sensing electrodes, and the commercial status of the various types of sensors. This review explores the fundamentals and practical applications of uric acid biosensors, addresses the current progress and future challenges, and would serve as a resource for the development of uric acid biosensors.