Uric acid in CKD: has the jury come to the verdict?

Abstract

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Fructose and Uric Acid: Major Mediators of Cardiovascular Disease Risk Starting at Pediatric Age

“…Uric acid internalization by URAT 1 is necessary for its deleterious and pro-apoptotic effect at the tubular level, and this is confirmed by the protective effect showed by losartan, which reduced TLR4, MCP1 and Nox4 expression [ 74 ]. Taken together with the association between increased serum uric acid levels and the more severe tubular atrophy and vascular damage described in different series of renal biopsy [ 75 , 76 , 77 , 78 , 79 , 80 ], these findings might explain, at least in part, the unfavorable renal outcomes related to hyperuricemia.…”

Management of Hyperuricemia in Patients with Chronic Kidney Disease: a Focus on Renal Protection

“…While the observed discrepancies in the outcomes of clinical trials on ULT in patients with CKD may indicate that not all patients will receive renal benefits of ULT, the discrepancies may also be due to a number of other factors, such as low sample size, short duration of follow-up, and lack of consistent definitions of CKD across studies as well as heterogeneity in study designs. Although current guidelines for management of CKD do not recommend treatment of hyperuricemia in the absence of a diagnosis of gout [75], there is increasing consensus that there is a direct causal relationship between high levels of serum urate and the development and progression of CKD [42,57]. ULT with a xanthine oxidase inhibitor should be considered as a therapeutic option in patients at high renal risk and/or declining renal function with hyperuricemia with and without deposition, even if additional studies are needed to identify threshold values for treatment and treatment targets.…”

“…A large number of studies have been carried out to investigate the effects of ULT on CKD progression (reviewed in [42,57,58]). While many trials have reported that ULT has a benefit on renal outcomes, others found that ULT provided no benefit [59].…”

“…What should be done in those with intermediate values remains unclear [76]. There is some discrepancy on whether or not ULT should be administered in the absence of progression of CKD, with some in favor of ULT only when clinically relevant progression is observed [42] and others advocating that all hyperuricemic patients with CKD can benefit from ULT [57]. However, once progression occurs, it is likely that damage to the kidney has already taken place, and thus early intervention might be considered with a preventive aim.…”

Identifying risk factors for chronic kidney disease stage 3 in adults with acquired solitary kidney from unilateral nephrectomy: a retrospective cohort study

“…We similarly found that hyperuricemia was an independent risk factor for CKD stage 3 among patients with ASK. However, the issue of whether the treatment of hyperuricemia would change the CKD outcomes is speculative, since it remains controversial whether hyperuricemia is a consequence or a cause (or both) of CKD [33]. Diabetic nephropathy is the most common cause of ESRD globally, and the presence of diabetes increases the risk of CKD, ESRD, and death [34].…”