Renal effects of uric acid: hyperuricemia and hypouricemia

Park, Jung Hwan; Jo, Yongsu; Lee, Jong-Ho

doi:10.3904/kjim.2020.410

Cited by 61 publications

(44 citation statements)

References 140 publications

(181 reference statements)

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“…It is well known that uric acid levels rise as kidney function decreases; however, there is controversy as to whether hyperuricemia directly worsens kidney function [ 71 , 72 ]. Although there is no consistent recommendation regarding the treatment of asymptomatic hyperuricemia in CKD patients, most Korean physicians treat asymptomatic hyperuricemia in CKD patients to prevent CKD progression and cerebrocardiovascular complications [ 73 ].…”

Section: Treatmentmentioning

confidence: 99%

Clinical and genetic characteristics of Korean autosomal dominant polycystic kidney disease patients

Park

Ryu

et al. 2021

Korean J Intern Med

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Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. It is characterized by cyst growth in the kidneys, resulting in kidney enlargement and end-stage kidney disease. The polycystic kidney disease 1 (PKD1) and PKD2 have been identified as genes related to ADPKD and their significance in the molecular pathology of the disease has been studied. A disease-modifying drug has been approved; therefore, it has become important to identify patients at a high risk of kidney disease progression. Genetic tests, image analysis methods, and clinical factors for kidney disease progression prediction have been established. This review describes genetic and clinical characteristics, and discusses ongoing studies in Korean ADPKD patients.

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Section: Treatmentmentioning

confidence: 99%

Clinical and genetic characteristics of Korean autosomal dominant polycystic kidney disease patients

Park

Ryu

et al. 2021

Korean J Intern Med

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“…This time, the pathogenesis is related to pro-inflammatory and pro-oxidative effects of UA. Other current pathogenesis incriminated in the onset and progression of already mentioned diseases are epithelial-to-mesenchymal transition in renal tubular cells, renal vasoconstriction mediated by endothelial dysfunction, and activation of renin-angiotensin system (RAAS) [ 12 ]. Some studies reported that high levels of uric acid may exert protective effects in neurological disorders, such as Parkinson’s disease [ 13 ], multiple sclerosis [ 14 , 15 ], Alzheimer’s disease [ 16 ], and vascular-disease-related dementia [ 2 ] through its extracellular anti-oxidative role.…”

Section: Introductionmentioning

confidence: 99%

Uric Acid and Oxidative Stress—Relationship with Cardiovascular, Metabolic, and Renal Impairment

Gherghina

Peride

Ţigliş

et al. 2022

IJMS

175

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Background: The connection between uric acid (UA) and renal impairment is well known due to the urate capacity to precipitate within the tubules or extra-renal system. Emerging studies allege a new hypothesis concerning UA and renal impairment involving a pro-inflammatory status, endothelial dysfunction, and excessive activation of renin–angiotensin–aldosterone system (RAAS). Additionally, hyperuricemia associated with oxidative stress is incriminated in DNA damage, oxidations, inflammatory cytokine production, and even cell apoptosis. There is also increasing evidence regarding the association of hyperuricemia with chronic kidney disease (CKD), cardiovascular disease, and metabolic syndrome or diabetes mellitus. Conclusions: Important aspects need to be clarified regarding hyperuricemia predisposition to oxidative stress and its effects in order to initiate the proper treatment to determine the optimal maintenance of UA level, improving patients’ long-term prognosis and their quality of life.

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“…It may be more appropriate to manage the SUA level in PD patients at a higher value within the normal accepted range. Because UA is the most abundant antioxidant in plasma, further research is needed to assess the safety of lowering serum UA to specific thresholds to produce safe guidelines [ 33 ], for men and women, and in patients with and without CVD or CKD [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis of low-level serum uric acid and cardiovascular events in patients on peritoneal dialysis

Kuang

et al. 2021

Int Urol Nephrol

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Background The impact of serum uric acid (SUA) on development of cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD) remains controversial, especially the impact of hypouricemia (HUA) on CVD. The aim of our study was to investigate the influence of low-level SUA on cardiovascular (CV) events in PD patients. Methods A retrospective cohort study was conducted.728 PD patients from February 1, 2010 to May 31, 2019 were enrolled. All demographic and laboratory data were collected at baseline and 6 months after PD treatment. The study cohort was divided into four groups according to SUA level (μmol/L) after 6 months of PD: Group1 (< 360), Group2 (360–420), Group3 (420–480), Group4 (≥ 480). The clinical characteristics of each group were analyzed. With Group2 as reference, logistic regression analysis was performed to investigate the correlation between SUA levels and risk of CV events in patients undergoing PD. Use Kaplan–Meier method to generate CV events risk graph. Results 728 patients were enrolled in this study, including 403 (55.4%) males and 325 (44.6%) females, with an average age of 48.66 ± 13.98 years; of which 158 (21.7%) patients developed CV events. Multivariate COX regression showed that after adjusting for multiple clinical factors, Group1 (HR = 1.92, 95% CI 1.17–3.15, P = 0.01), Group3 (HR = 1.89, 95% CI 1.13–3.15, P = 0.015), and Group4 (HR = 2.38, 95% CI 1.35–4.19, P = 0.003) are all independent risk factors for developing CV events. The Kaplan–Meier risk curve of CV events showed that the risk of CV events in the Group1, Group3 and Group4 were significantly higher (Log-Rank = 12.67; P = 0.005). Restricted cubic spline (RCS) showed that SUA level is non-linearly associated with the risk of CV events, showing an U -shaped curve ( =13.3 P = 0.01). Conclusions Our study suggested that patients with SUA level less than 360 μmol/L also exhibited the higher risk for developing CV events, an U-shaped association between SUA level and risk of CV events in patients undergoing PD. Both SUA levels below 360 μmol/L and above 420 μmol/L were found to be significant risk factors for developing CV events in patients undergoing long-term PD.

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Renal effects of uric acid: hyperuricemia and hypouricemia

Cited by 61 publications

References 140 publications

Clinical and genetic characteristics of Korean autosomal dominant polycystic kidney disease patients

Clinical and genetic characteristics of Korean autosomal dominant polycystic kidney disease patients

Uric Acid and Oxidative Stress—Relationship with Cardiovascular, Metabolic, and Renal Impairment

Correlation analysis of low-level serum uric acid and cardiovascular events in patients on peritoneal dialysis

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