Hyperuricemia and chronic kidney disease: to treat or not to treat

Abstract Hyperuricemia is common in chronic kidney disease (CKD) and may be present in 50% of patients presenting for dialysis. Hyperuricemia can be secondary to impaired glomerular filtration rate (GFR) that occurs in CKD. However, hyperuricemia can also precede the development of kidney disease and predict incident CKD. Experimental studies of hyperuricemic models have found that both soluble and crystalline uric acid can cause significant kidney damage, characterized by ischemia, tubulointerstitial fibrosis, and inflammation. However, most Mendelian randomization studies failed to demonstrate a causal relationship between uric acid and CKD, and clinical trials have had variable results. Here we suggest potential explanations for the negative clinical and genetic findings, including the role of crystalline uric acid, intracellular uric acid, and xanthine oxidase activity in uric acid-mediated kidney injury. We propose future clinical trials as well as an algorithm for treatment of hyperuricemia in patients with CKD.

摘要：高尿酸血症（Hyperuricemia）在慢性肾脏病（chronic kidney disease, CKD）中颇为常见，接受透析治疗的患者中约50%可出现该病症。高尿酸血症可继发于慢性肾脏病患者出现的肾小球滤过率（glomerular filtration rate, GFR）受损。不过，高尿酸血症也可先于肾脏病发病，并可预测新发慢性肾脏病。高尿酸血症模型的实验研究显示，可溶性尿酸与结晶型尿酸均可造成严重肾损伤，其病理特征表现为缺血、肾小管间质纤维化及炎症反应。然而，多数孟德尔随机化（Mendelian randomization）研究未能证实尿酸与慢性肾脏病之间存在因果关系，且临床试验的结果并不一致。本文针对此类临床与遗传学阴性研究结果提出了潜在解释，包括结晶型尿酸、细胞内尿酸以及黄嘌呤氧化酶（xanthine oxidase）活性在尿酸介导的肾损伤中的作用。此外，本文还提出了未来临床试验的方向，以及慢性肾脏病患者高尿酸血症的治疗算法。

搜集汇总

背景与挑战

背景概述

该数据集聚焦于高尿酸血症与慢性肾脏病（CKD）的关联研究，包含实验数据和临床观察，探讨了尿酸在肾脏损伤中的作用及治疗策略。数据集发布于2022年，属于肾脏病学和泌尿学领域，采用CC BY 4.0许可。