Could uric acid have a role in acute renal failure?
Could uric acid have a role in acute renal failure?
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DOI：
10.2215/cjn.00350106
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发表时间：
2007-01-01
影响因子：
9.8
通讯作者：
Johnson, Richard J.
中科院分区：
文献类型：
--
作者：
Ejaz, A. Ahsan;Mu, Wei;Johnson, Richard J.
急性肾衰竭（ARF），无论是由毒素或缺血引起的，与显着的发病率。ARF的发病机制是复杂的，其特征在于与肾小管和微血管损伤以及间质炎症相关的肾血管收缩和氧化应激。在许多情况下，ARF与血清尿酸升高有关，这是由于生成增加和排泄减少的结果。尽管人们普遍认为尿酸水平显著升高可通过肾小管内过饱和伴结晶和肾内梗阻（“急性尿酸盐肾病”）引起ARF，但尚未考虑尿酸在不导致肾小管梗阻的浓度下可能影响肾脏结局的可能性。本文综述了尿酸对生物过程的有益和不利影响，并提出了高尿酸血症，特别是慢性和显著的高尿酸血症，可能是ARF的真正危险因素的假设。高尿酸血症也可能解释了利尿剂在ARF治疗中缺乏益处的矛盾现象。提示慢性高尿酸血症对急性肾小管损伤后肾脏转归的影响尚需进一步研究。
Acute renal failure (ARF), induced by either toxins or ischemia, is associated with significant morbidity. The pathogenesis of ARF is complex and is characterized by renal vasoconstriction and oxidative stress in association with tubular and microvascular injury and interstitial inflammation. In many situations, ARF is associated with a rise in serum uric acid as a result of both increased generation and decreased excretion. Although it is widely recognized that markedly elevated levels of uric acid can cause ARF via supersaturation within the tubules with crystallization and intrarenal obstruction ("acute urate nephropathy"), the possibility that uric acid may affect renal outcomes at concentrations that do not lead to tubular obstruction have not been considered. This article reviews both the salutary and the adverse effects of uric acid on biologic processes and presents the hypothesis that hyperuricemia, particularly if chronic and marked, likely represents a true risk factor for ARF. Hyperuricemia also may account for the paradoxic lack of benefit of diuretics in the management of ARF. It is suggested that studies are needed to investigate the role of chronic hyperuricemia on renal outcomes after acute tubular injury.