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Associations Between Hyperuricemia and Chronic Kidney Disease: A Review.

Prasad Sah OS, Qing YX - Nephrourol Mon (2015)

Bottom Line: The most common risk factors for CKD are obesity and the metabolic syndrome, which is strongly associated with hyperuricemia probably as a consequence of insulin resistance and the effects of insulin to reduce the urinary urate excretion.Although many evidence-based studies have suggested that uric acid itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of controversy.Special attention should be paid to specific contraindications to certain drugs and the possibility of infectious arthritis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

ABSTRACT

Context: In human beings, uric acid is the poorly soluble circulating end product of the purine nucleotide metabolism. A reduction in the glomerular filtration rate (GFR) contributes to hyperuricemia, which is frequently observed in patients with chronic kidney disease (CKD).

Evidence acquisition: Hyperuricemia is defined as a serum uric acid level > 7.0 mg/dL in males and > 6.0 mg/dL in females, while CKD is defined as kidney damage or a GFR < 60 mL/min/1.73 m(2) for 3 months or more, irrespective of the cause. Hyperuricemia is common in CKD and may occur because of decreased excretion, increased production, or a combination of both mechanisms.

Results: The causes for hyperuricemia in overproducers may be either exogenous or endogenous. CKD has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. The most common risk factors for CKD are obesity and the metabolic syndrome, which is strongly associated with hyperuricemia probably as a consequence of insulin resistance and the effects of insulin to reduce the urinary urate excretion. For recurring bouts of hyperuricemia or gout, patients should have a blood test and joint fluid test to determine whether the medication taken is effective. Interventional studies are a useful clinical research tool in clarifying the role of hyperuricemia in CKD.

Conclusions: Although many evidence-based studies have suggested that uric acid itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of controversy. Special attention should be paid to specific contraindications to certain drugs and the possibility of infectious arthritis.

No MeSH data available.


Related in: MedlinePlus

Putative Mechanisms by Which Elevated Serum Uric Acid Levels May Contribute to Chronic Kidney Disease Development and Progression
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fig19863: Putative Mechanisms by Which Elevated Serum Uric Acid Levels May Contribute to Chronic Kidney Disease Development and Progression

Mentions: Uric acid has been shown to activate the cytoplasmic phospholipase A2 and inflammatory transcription factor nuclear factor-κB (NF-κB), leading to the inhibition of proximal tubular cellular proliferation in vitro (21). Increasing serum uric acid levels include systemic cytokine production, i.e. tumor necrosis factor α (22), and the local expression of chemokines, i.e. monocyte chemotactic protein 1 in the kidney (23, 24) and cyclooxygenase 2 (COX-2) in blood vessels (24). The withdrawal of uric acid lowering therapy was found to increase urinary transforming growth factor-β1 in a group of HUA patients with CKD (25). The putative mechanisms by which increased serum uric acid levels may contribute to CKD onset and progression are shown in Figure 2.


Associations Between Hyperuricemia and Chronic Kidney Disease: A Review.

Prasad Sah OS, Qing YX - Nephrourol Mon (2015)

Putative Mechanisms by Which Elevated Serum Uric Acid Levels May Contribute to Chronic Kidney Disease Development and Progression
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4537598&req=5

fig19863: Putative Mechanisms by Which Elevated Serum Uric Acid Levels May Contribute to Chronic Kidney Disease Development and Progression
Mentions: Uric acid has been shown to activate the cytoplasmic phospholipase A2 and inflammatory transcription factor nuclear factor-κB (NF-κB), leading to the inhibition of proximal tubular cellular proliferation in vitro (21). Increasing serum uric acid levels include systemic cytokine production, i.e. tumor necrosis factor α (22), and the local expression of chemokines, i.e. monocyte chemotactic protein 1 in the kidney (23, 24) and cyclooxygenase 2 (COX-2) in blood vessels (24). The withdrawal of uric acid lowering therapy was found to increase urinary transforming growth factor-β1 in a group of HUA patients with CKD (25). The putative mechanisms by which increased serum uric acid levels may contribute to CKD onset and progression are shown in Figure 2.

Bottom Line: The most common risk factors for CKD are obesity and the metabolic syndrome, which is strongly associated with hyperuricemia probably as a consequence of insulin resistance and the effects of insulin to reduce the urinary urate excretion.Although many evidence-based studies have suggested that uric acid itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of controversy.Special attention should be paid to specific contraindications to certain drugs and the possibility of infectious arthritis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

ABSTRACT

Context: In human beings, uric acid is the poorly soluble circulating end product of the purine nucleotide metabolism. A reduction in the glomerular filtration rate (GFR) contributes to hyperuricemia, which is frequently observed in patients with chronic kidney disease (CKD).

Evidence acquisition: Hyperuricemia is defined as a serum uric acid level > 7.0 mg/dL in males and > 6.0 mg/dL in females, while CKD is defined as kidney damage or a GFR < 60 mL/min/1.73 m(2) for 3 months or more, irrespective of the cause. Hyperuricemia is common in CKD and may occur because of decreased excretion, increased production, or a combination of both mechanisms.

Results: The causes for hyperuricemia in overproducers may be either exogenous or endogenous. CKD has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. The most common risk factors for CKD are obesity and the metabolic syndrome, which is strongly associated with hyperuricemia probably as a consequence of insulin resistance and the effects of insulin to reduce the urinary urate excretion. For recurring bouts of hyperuricemia or gout, patients should have a blood test and joint fluid test to determine whether the medication taken is effective. Interventional studies are a useful clinical research tool in clarifying the role of hyperuricemia in CKD.

Conclusions: Although many evidence-based studies have suggested that uric acid itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of controversy. Special attention should be paid to specific contraindications to certain drugs and the possibility of infectious arthritis.

No MeSH data available.


Related in: MedlinePlus