Associations Between Hyperuricemia and Chronic Kidney Disease: A Review.
Associations Between Hyperuricemia and Chronic Kidney Disease: A Review.
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DOI：
10.5812/numonthly.7(3)2015.27233
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发表时间：
2015-05
影响因子：
--
通讯作者：
Qing YX
中科院分区：
文献类型：
--
作者：
Prasad Sah OS;Qing YX
在人类中，尿酸是嘌呤核苷酸代谢的难溶性循环终产物。肾小球滤过率（GFR）的降低会导致高尿酸血症，这在慢性肾病（CKD）患者中常见。高尿酸血症定义为男性血清尿酸水平> 7.0 mg/dL，女性血清尿酸水平> 6.0 mg/dL，而CKD定义为肾损伤或GFR < 60 mL/min/1.73 m2持续3个月或更长时间，无论原因如何。高尿酸血症在CKD中很常见，可能是由于排泄减少、产生增加或两种机制的结合而发生。高尿酸血症的原因可能是外源性或内源性的。CKD已成为一个全球性的公共卫生问题，因为它的高患病率和伴随的终末期肾病，心血管疾病和过早死亡的风险增加。CKD最常见的风险因素是肥胖和代谢综合征，其与高尿酸血症密切相关，可能是胰岛素抵抗和胰岛素减少尿尿酸排泄的作用的结果。对于反复发作的高尿酸血症或痛风，患者应进行血液检查和关节液检查，以确定所服用的药物是否有效。干预性研究是阐明高尿酸血症在CKD中的作用的有用的临床研究工具。尽管许多循证研究表明，尿酸本身可能通过增加炎症和CKD进展而损害CKD患者，但这个问题仍然是一个有争议的问题。应特别注意某些药物的特定禁忌症以及感染性关节炎的可能性。
In human beings, uric acid is the poorly soluble circulating end product of the purine nucleotide metabolism. A reduction in the glomerular filtration rate (GFR) contributes to hyperuricemia, which is frequently observed in patients with chronic kidney disease (CKD). Hyperuricemia is defined as a serum uric acid level > 7.0 mg/dL in males and > 6.0 mg/dL in females, while CKD is defined as kidney damage or a GFR < 60 mL/min/1.73 m2 for 3 months or more, irrespective of the cause. Hyperuricemia is common in CKD and may occur because of decreased excretion, increased production, or a combination of both mechanisms. The causes for hyperuricemia in overproducers may be either exogenous or endogenous. CKD has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. The most common risk factors for CKD are obesity and the metabolic syndrome, which is strongly associated with hyperuricemia probably as a consequence of insulin resistance and the effects of insulin to reduce the urinary urate excretion. For recurring bouts of hyperuricemia or gout, patients should have a blood test and joint fluid test to determine whether the medication taken is effective. Interventional studies are a useful clinical research tool in clarifying the role of hyperuricemia in CKD. Although many evidence-based studies have suggested that uric acid itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of controversy. Special attention should be paid to specific contraindications to certain drugs and the possibility of infectious arthritis.