Serum Uric Acid Level Predicts Progression of IgA Nephropathy in Females but Not in Males.
Serum Uric Acid Level Predicts Progression of IgA Nephropathy in Females but Not in Males.
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DOI：
10.1371/journal.pone.0160828
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Nakanishi T
中科院分区：
文献类型：
--
作者：
Nagasawa Y;Yamamoto R;Shoji T;Shinzawa M;Hasuike Y;Nagatoya K;Yamauchi A;Hayashi T;Kuragano T;Moriyama T;Isaka Y;Nakanishi T
免疫球蛋白A肾病（IgAN）是肾小球肾炎最常见的形式之一。在这一点上，高尿酸血症对IgAN的临床影响尚不清楚。本研究的目的是探讨高尿酸血症对IgAN进展的临床影响。多中心回顾性队列研究。在大坂大学医院、大坂综合医院和大坂Rosai医院通过肾活检诊断的935名IgAN患者。被纳入本研究。肾活检时的尿酸水平。关注的结局是从肾活检到观察到基线血清肌酐水平升高50%的时间，这被定义为“进展”。根据诊断时的肾活检，从病历中收集基线特征，包括年龄、性别、体重指数、高血压、糖尿病（使用降糖药物）、血清肌酐水平、尿蛋白、吸烟状况、RAAS阻断剂和类固醇治疗。血清尿酸水平升高是女性患者进展的独立风险因素（每1.0 mg/dL，多变量校正的发生率比1.33 [95%置信区间1.07，1.64]，P = 0.008），但在男性患者中并非如此（1.02 [0.81，1.29]，P = 0.855）。为了控制肾功能对女性患者血清尿酸水平与疾病进展之间相关性的混杂效应，进行了年龄和血清肌酐匹配和倾向评分匹配分析，这些结果也支持尿酸对肾脏疾病进展的影响不依赖于基础肾功能。一个队列分析了阿托伐他汀。这项研究表明，尿酸水平升高是女性IgAN患者ESKD的独立危险因素。因此，尿酸可能是女性IgAN患者的治疗目标。
Immunoglobulin A nephropathy (IgAN) is one of most common forms of glomerulonephritis. At this point, the clinical impact of hyperuricemia on IgAN is not clear. The aim of the present study was to explore the clinical impact of hyperuricemia on the progression of IgAN. Multicenter retrospective cohort study. 935 IgAN patients who were diagnosed by kidney biopsy at Osaka University Hospital, Osaka General Hospital, and Osaka Rosai Hospital. were included in this study. Uric acid levels at renal biopsy. The outcome of interest was the time from the kidney biopsy to the time when a 50% increase in the baseline serum creatinine level was observed, which was defined as "progression". The baseline characteristics according to the kidney biopsy at the time of diagnosis were collected from the medical records, and included age, gender, body mass index, hypertension, diabetes (use of antidiabetic drugs), serum levels of creatinine, urinary protein, smoking status, RAAS blockers and steroid therapy. An elevated serum uric acid level was an independent risk factor for progression in female patients (per 1.0 mg/dL, multivariate-adjusted incident rate ratio 1.33 [95% confidence interval 1.07, 1.64], P = 0.008) but not in male patients (1.02 [0.81, 1.29], P = 0.855). To control a confounding effect of renal function on an association between serum uric acid level and progression in female patients, age- and serum creatinine-matched and propensity score-matched analyses were performed, and these results also supported the effect by uric acid on kidney disease progression independent of basal kidney function. A cohort analyzed retorospectively. This study revealed that an elevated uric acid level was an independent risk factor for ESKD in female IgAN patients. Therefore, uric acid might be a treatable target in female IgAN patients.