Renal Handling of Uric Acid

Rieselbach, Richard E.

doi:10.1007/978-1-4684-3285-5_1

Cited by 11 publications

(7 citation statements)

References 35 publications

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“…Uric acid is subsequently filtered by the glomeruli, reabsorbed in the proximal tubule only to be later secreted by a distal segment of the proximal tubule [23]. Serum concentrations of uric acid are affected by diet [24], metabolism [25], cell turnover [26], and kidney function [27].…”

Section: Discussionmentioning

confidence: 99%

Serum uric acid and the risk of mortality during 23 years follow-up in the Scottish Heart Health Extended Cohort Study

Juraschek¹,

Tunstall‐Pedoe²,

Woodward³

2014

Atherosclerosis

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Background Elevated uric acid is a prevalent condition with controversial health consequences. Observational studies disagree with regard to the relationship of uric acid with mortality, and with factors modifying this relationship. Objective We examined the association of serum uric acid with mortality in 15,083 participants in the Scottish Heart Health Extended Cohort (SHHEC) Study. Methods Serum uric acid measured at study enrollment. Death was ascertained using both the Scottish death register and record linkage. Results During a median follow-up of 23 years, there were 3,980 deaths. In Cox proportional hazards models with sexes combined, those in the highest fifth of uric acid had significantly greater mortality (HR 1.18, 95% CI: 1.06, 1.31) compared with the second fifth, after adjustment for traditional cardiovascular risk factors. This relationship was modified by sex (P-interaction = 0.002) with adjusted HRs of 1.69 (95% CI: 1.40, 2.04) and 0.99 (95% CI: 0.86, 1.14) in women and men, respectively. Compared with the second fifth, the highest fifth of uric acid was most associated with kidney-related death (HR: 2.08, 95% CI: 1.31, 3.32). Conclusion Elevated uric acid is associated with earlier mortality, especially in women. Future studies should evaluate mechanisms for these interactions and explore the strong association with renal-related mortality.

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Section: Discussionmentioning

confidence: 99%

Serum uric acid and the risk of mortality during 23 years follow-up in the Scottish Heart Health Extended Cohort Study

Juraschek¹,

Tunstall‐Pedoe²,

Woodward³

2014

Atherosclerosis

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“…The kidney is responsible for 70% of urate elimination [5,29,30]. Uric acid is freely filtered by the kidney and undergoes reabsorption and secretion in the proximal tubule [31]. Several clinical studies have linked both reduced renal filtration [11,13] and impaired tubular secretion with gout [11,32].…”

Section: Discussionmentioning

confidence: 99%

Association of kidney disease with prevalent gout in the United States in 1988–1994 and 2007–2010

Juraschek

Kovell

Miller

et al. 2013

Seminars in Arthritis and Rheumatism

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Objective To determine the prevalence of gout associated with progressive degrees of kidney disease in the US population. Methods We performed a cross-sectional analysis among non-institutionalized adults (age 20 and older) of the National Health and Nutrition Examination Surveys in 1988–1994 and 2007–2010. Gout status was ascertained by self-report of physician-diagnosed gout. Chronic kidney disease (CKD) was defined in stages based on estimated glomerular filtration rate (GFR) and single albuminuria measurements (albumin-to-creatinine ratio). Prevalence ratios comparing successive categories of GFR, albuminuria, and CKD as well as temporal trends over a 22-year interval were determined via Poisson regression. Results In the US, the crude prevalence of gout was 2–3% among participants without CKD, 4% among participants with CKD stage 1, 6–10% for stage 2, 11–13% for stage 3, and over 30% for stage 4. The adjusted prevalence ratio comparing the CKD stage 4 stratum to participants without CKD was 3.20 (95% CI: 1.96, 5.24) in 2007–2010 and remained significant even after adjustment for serum uric acid. Notably, there was a statistically significant, progressively greater adjusted prevalence ratio of gout associated with successively lower categories of GFR and higher categories of albuminuria. Conclusions Among US adults, there exists a strong dose–response association between impaired renal function and prevalent gout. Health providers should be aware of the elevated burden of gout among patients with CKD especially when evaluating new onset joint pain and swelling.

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“…Second, the potential genetic contributions to gout risk in the 85% to 90% of patients with gout with impaired renal uric acid clearance 2,4,9 remained unclear until molecular analyses of urate transporters in the kidney and other organs became accessible. In recent years, cloning, sequencing, and tissue/organ expression profiles of multiple renal anion transporter/exchanger genes have been accomplished 9 , revealing an array of carrier molecules involved in the renal proximal tubular urate reabsorption and secretion functions operationally defined in prior years by classical renal physiologic and pharmacologic analyses 10 .…”

Section: Rheumatologymentioning

confidence: 99%