Clinical Outcome of Hyperuricemia in IgA Nephropathy: A Retrospective Cohort Study and Randomized Controlled Trial
Clinical Outcome of Hyperuricemia in IgA Nephropathy: A Retrospective Cohort Study and Randomized Controlled Trial
复制标题
IgA 肾病高尿酸血症的临床结果：回顾性队列研究和随机对照试验
DOI：
10.1159/000331453
复制
发表时间：
2012-01-01
影响因子：
2.8
通讯作者：
Yu, Xueqing
中科院分区：
文献类型：
--
作者：
Shi, Yongjun;Chen, Wei;Yu, Xueqing
背景：高尿酸血症是伊加肾病（IgAN）肾脏进展的独立危险因素。然而，没有研究评估别嘌呤醇对高尿酸血症IgAN临床结局的影响。研究方法：首先，对353例IgAN患者进行了一项回顾性队列研究，以探讨平均5年内尿酸（UA）与肾脏疾病进展之间的关系。然后，40例高尿酸血症IgAN患者随机接受别嘌呤醇（100-300 mg/d）或常规治疗6个月。研究结局为肾脏疾病进展和/或血压。结果如下：高尿酸血症独立预测校正不同基线估计肾小球滤过率后1、3和5年的肾存活率。在随机对照试验中，别嘌呤醇没有显著改变肾脏进展或蛋白尿。别嘌呤醇组9例高血压患者中有7例降压药用量减少，对照组9例降压药用量无减少（P < 0.01）。血压正常者UA水平与平均动脉压呈正相关（r = 0.388，P < 0.001）。结论：高尿酸血症预测IgAN的进展独立于基线估计的肾小球滤过率。别嘌呤醇可改善血压控制。降低尿酸对IgAN的肾脏保护作用还需进一步研究。
Background: Hyperuricemia is an independent risk factor for renal progression in IgA nephropathy (IgAN). However, no study has evaluated the effect of allopurinol on the clinical outcome in hyperuricemic IgAN. Methods: First,a retrospective cohort study of 353 IgAN patients was conducted to explore the relationship between uric acid (UA) and the progression of renal disease over a mean period of 5 years. Then, 40 hyperuricemic IgAN patients were randomized to receive allopurinol (100–300 mg/day) or usual therapy for 6 months. The study outcomes were renal disease progression and/or blood pressure. Results: Hyperuricemia independently predicted renal survival at 1, 3, and 5 years after adjustment for different baseline estimated glomerular filtration rates. In the randomized controlled trial, allopurinol did not significantly alter renal progression or proteinuria. The antihypertensive drug dosage was reduced in 7 of 9 cases with hypertension in the allopurinol group compared to 0 of 9 cases in the control group (p < 0.01). UA levels correlated with mean arterial pressure in normotensive patients (r = 0.388, p < 0.001). Conclusion: Hyperuricemia predicts the progression of IgAN independently of baseline estimated glomerular filtration rate. Allopurinol may improve the control of blood pressure. Further studies are required to explore the effects of lowering UA on renal protection in IgAN.