Elevated Uric Acid Increases the Risk for Acute Kidney Injury

Lapsia, Vijay; Johnson, Richard J.; Dass, Bhagwan; Shimada, Michiko; Kambhampati, Ganesh; Ejaz, Noel I.; Arif, Amir A.; Ejaz, A. Ahsan

doi:10.1016/j.amjmed.2011.06.021

Cited by 94 publications

(102 citation statements)

References 26 publications

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“…The same group reported a retrospective study in which they found that pre-operative SUA was associated with an increased incidence and a risk for AKI, higher postoperative serum creatinine values, and longer hospital length of stay in patients undergoing cardiac surgery. 30 Interestingly this study also showed that lower SUA levels were also associated with an increased risk of developing AKI. Lastly Ejaz et al 12 conducted a prospective observational study in which they evaluated relationships between SUA, uNGAL and interleukin-18, serum monocyte chemoattractant protein-1 and tumor necrosis factor-alpha, and incidence of AKI.…”

Section: Discussionmentioning

confidence: 51%

Serum uric acid may predict development of progressive acute kidney injury after open heart surgery

et al. 2014

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Objectives: Acute kidney injury (AKI) is a common complication of cardiac surgery developing in 25-35% cases. Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine. Some studies demonstrated the predictive role of post-operative serum uric acid (SUA) as an early marker of AKI. We aimed to study the role of serum and urine NGAL as well as SUA to predict progression of AKI. Design and methods: This is a prospective observational study of patients undergoing cardiac surgery. Blood and urine samples for measurement of uric acid, serum and urine NGAL levels were collected prior to cardiac surgery (0 h), and in the time course at 2nd and 24th hours after surgery. Patients who developed AKI were divided into two subgroups as progressing and non-progressing AKI.Results: Sixty patients (42 males, 18 females) were included. After cardiac surgery, 40 patients developed AKI, 20 of whom non-progressing AKI, and 20 progressing AKI. All of the markers significantly increased in AKI patients. A receiver operator characteristics (ROC) curve analysis showed higher predictive ability of SUA for progressing AKI compared with serum and urine NGAL. When compared markers obtained at the second hour after surgery, UA had significantly large AUC than NGAL to predict AKI developed at 24 and 48 h, particularly in patients, who require renal replacement therapy (RRT). Conclusion: Uric acid seems to predict the progression of AKI and RRT requirement in patients underwent cardiac surgery better than NGAL.

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Section: Discussionmentioning

confidence: 51%

Serum uric acid may predict development of progressive acute kidney injury after open heart surgery

et al. 2014

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“…An elevated serum UA level has been reported to be an independent risk factor for the development of chronic kidney disease [7][8][9] ; however, limited data is available regarding its relation to AKI. Recent data suggested that elevated UA levels increase the risk of AKI in patients undergoing cardiac surgery [14,15] . A report by Park et al [16] demonstrated that among patients undergoing PCI, those with AKI had higher UA levels, and that UA was independently associated with the risk for AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated serum UA levels were also associated with increased short-and long-term mortality among myocardial infarction patients [10][11][12][13] . Previous studies have shown that elevated UA levels increase the risk of AKI in patients undergoing cardiac surgery [14,15] and nonemergent PCI [16] . To our knowledge, there are no previous reports of the effect of UA levels on AKI in STEMI patients undergoing primary PCI, in whom preprocedural preparatory measures to reduce AKI are often underutilized due to the need for emergent reperfusion therapy.…”

Section: Introductionmentioning

confidence: 99%

Serum Uric Acid Levels and Renal Impairment among ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

et al. 2016

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Background: Elevated serum uric acid (UA) levels are associated with adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). However, the relation between UA and acute kidney injury (AKI) in this population is unclear. We evaluated the effect of elevated UA levels on the risk to develop AKI among consecutive STEMI patients treated with primary PCI. Methods: We performed a retrospective analysis of 1,372 consecutive patients admitted with the diagnosis of STEMI between January 2008 and February 2015. Patients were stratified into quartiles according to UA levels as follows: quartile 1, <4.7 mg/dl; quartile 2, 4.8 to <5.6 mg/dl; quartile 3, 5.7 to <6.6 mg/dl, and quartile 4, >6.7 mg/dl. Results: STEMI patients with elevated UA levels had a higher frequency of AKI (4 vs. 6% vs. 10 vs. 24%; p < 0.001). In a subgroup analysis of patients with reduced baseline estimated glomerular filtration rate ( ≤ 60 ml/min/1.73 m 2 ), an elevated UA level was associated with a significant risk to develop AKI, with 46% of patients developing AKI in the highest UA quartile. In a multivariate logistic regression model, for every 1-mg/dl increase in the UA concentration, the adjusted risk for AKI increased by 46% (OR = 1.46, 95% CI 1.18-1.66; p < 0.001). Conclusions: Among STEMI patients undergoing primary PCI, elevated UA levels are an independent predictor of AKI.

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“…Hyperuricemia is common in subjects with Mesoamerican Nephropathy. In turn, hyperuricemia has been recognized as a risk factor for both acute and chronic kidney injury [12,13]. The mechanism may involve uric acid-induced vasculopathy with the development of glomerular hypertension [14], as well as direct tubular effects resulting in epithelial mesenchymal transition [15].…”

Section: Figmentioning

confidence: 99%

Mechanisms by Which Dehydration May Lead to Chronic Kidney Disease

et al. 2015

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Dehydration, a condition that characterizes excessive loss of body water, is well known to be associated with acute renal dysfunction; however, it has largely been considered reversible and to be associated with no long-term effects on the kidney. Recently, an epidemic of chronic kidney disease has emerged in Central America in which the major risk factor seems to be recurrent heat-associated dehydration. This has led to studies investigating whether recurrent dehydration may lead to permanent kidney damage. Three major potential mechanisms have been identified, including the effects of vasopressin on the kidney, the activation of the aldose reductase-fructokinase pathway, and the effects of chronic hyperuricemia. The discovery of these pathways has also led to the recognition that mild dehydration may be a risk factor in progression of all types of chronic kidney diseases. Furthermore, there is some evidence that increasing hydration, particularly with water, may actually prevent CKD. Thus, a whole new area of investigation is developing that focuses on the role of water and osmolarity and their influence on kidney function and health.

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Elevated Uric Acid Increases the Risk for Acute Kidney Injury

Cited by 94 publications

References 26 publications

Serum uric acid may predict development of progressive acute kidney injury after open heart surgery

Serum uric acid may predict development of progressive acute kidney injury after open heart surgery

Serum Uric Acid Levels and Renal Impairment among ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

Mechanisms by Which Dehydration May Lead to Chronic Kidney Disease

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