Hyperuricemia as a Predictive Marker for Progression of Nephrosclerosis: Clinical Assessment of Prognostic Factors in Biopsy-Proven Arterial/Arteriolar Nephrosclerosis

Abstract

Aim: The influence of serum urate on kidney disease is attracting attention, but the effects of uric acid (UA) on nephrosclerosis have not been elucidated.Methods: We reviewed data from 45 patients diagnosed with arterial/arteriolar nephrosclerosis. The renal outcomes of the arterial/arteriolar nephrosclerosis patients were assessed by performing logistic and Cox regression analyses. A Kaplan-Meier analysis was used to evaluate the impact of hyperuricemia (HU) on kidney survival. The renal outcomes of patients with and without HU were compared by using a propensity score-matched cohort.Results: The logistic regression models showed no significant differences in renal outcomes, according to baseline parameters or follow-up parameters, except the serum UA value and body mass index (BMI). Baseline serum UA level had the highest odds ratio (OR) for estimated glomerular filtration rate (eGFR) decline (OR, 1.86; 95% confidence interval (CI), 1.12 to 3.45), among the parameters assessed. In the multivariate Cox regression analysis, HU (UA ≥ 8.0 mg/dL) (P = 0.01) and BMI (P = 0.03) were significantly associated with a ≥ 50% eGFR decline or ESRD. The Kaplan-Meier analysis in the propensity score-matched cohort indicated that the renal survival rate of the group of arterial/arteriolar nephrosclerosis patients with HU was significantly lower than that of the group without HU (log rank, P = 0.03).Conclusion: The results of this study suggest that the baseline serum UA value can serve as a renal outcome predictor in arterial/arteriolar nephrosclerosis patients.

Association of renal arteriosclerosis and hypertension with renal and cardiovascular outcomes in Japanese type 2 diabetes patients with diabetic nephropathy

“…Although renal AS might be associated with concurrent HT, it is sometimes found even in patients without HT. Previous studies showed that renal AS was associated with aging, postprandial hyperglycemia and hyperinsulinemia, low serum high‐density lipoprotein cholesterol, hyperuricemia, and chronic inflammation. In contrast, a BP <140/90 mmHg is recommended to reduce ESRD and cardiovascular disease among people with diabetes in clinical practice.…”

Hyperuricemia as a trigger of immune response in hypertension and chronic kidney disease

“…89 This hypothesis was also supported by a subsequent study showing that hyperuricemia independently predicted renal survival in patients with biopsy-proven arteriolosclerosis. 90 Moreover, hyperuricemia was found to increase the risk of segmental glomerulosclerosis, tubular atrophy, and interstitial fibrosis after adjustment for serum creatinine, age, and blood pressure. 91 Whether hyperuricemia may also accelerate the progression of specific renal diseases is still uncertain.…”

Hyperuricemia as a Predictor of Progression of Chronic Kidney Disease: A Matched Cohort Analysis

“…The precise mechanism of the nephrotoxicity of HU also remains unknown. However, HU has been found to induce systemic hypertension and afferent arteriolar sclerosis in animal models [47] [48], and high serum UA levels have been reported to be associated with renal arteriolosclerosis in humans [4] [49] [50].…”

“…The impact of the serum uric acid (UA) on renal prognosis of CKD patients has recently been attracting attention [3], and our group has reported finding that the serum UA value can serve as a predictor of progression of kidney disease in biopsy-proven nephrosclerosis patients [4]. However, because the serum UA elevation due to the decreased renal UA clearance in CKD patients makes it difficult to assess the role of UA in the progression of CKD, the predictive value of UA in regard to the progression of CKD remains a matter of controversy [5]- [11].…”