Increased serum uric acid levels are associated to renal arteriolopathy and predict poor outcome in IgA nephropathy
Increased serum uric acid levels are associated to renal arteriolopathy and predict poor outcome in IgA nephropathy
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DOI：
10.1016/j.numecd.2020.07.038
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发表时间：
2020-11-27
影响因子：
3.9
通讯作者：
Viazzi, Francesca
中科院分区：
文献类型：
--
作者：
Russo, Elisa;Drovandi, Stefania;Viazzi, Francesca
背景和目标：伊加肾病（IgAN）是世界范围内最常见的原发性肾小球肾炎，也是终末期肾病（ESRD）的主要原因。除经典进展因素外，其他动脉粥样硬化相关因素，包括高尿酸血症（HU），与IgAN的肾脏进展相关。血尿酸（SUA）水平升高是心血管疾病和肾脏疾病的常见并发症，并被认为与小动脉损伤（AD）的发生有关。本研究的目的是探讨SUA水平之间的相关性，肾损害及其影响的结果在IgAN patients.Methods和结果：临床，实验室和组织学资料的145例活检证实IgAN收集和回顾性分析，以确定SUA水平，肾损害和主要结局（死亡或终末期肾病）之间的相关性。活组织检查证实的AD定义为存在小动脉玻璃样变性和/或内膜增厚。HU定义为最高SUA性别特异性三分位数，男性>7.7 mg/dl，女性>6.2 mg/ dl。AD的患病率随着SUA水平三分位数的增加而增加（p = 0.02）。在logistic回归分析中，SUA与AD的存在独立相关（OR 1.75 [95%CI 1.10-2.93]，p = 0.03）。HU和AD对IgAN的进展有协同作用。AD和HU的患者，表现出减少的生存率从主要结果相比，只有一个危险因素或两者都没有（p = 0.01）。结论：SUA水平与AD和预后不良的IgAN患者的独立相关。(C)2020年意大利糖尿病学会，意大利动脉粥样硬化研究学会，意大利人类营养学会和临床医学和外科学系，费德里科二世大学。Elsevier B. V.出版，保留所有权利。
Background and aims: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide and a leading cause of end stage renal disease (ESRD). In addition to classical progression factors, other atherosclerosis-related factors, including hyperuricemia (HU), have been associated to the renal progression of IgAN. Increased serum uric acid (SUA) levels are well known to be concomitant of cardiovascular and kidney diseases, and have been proposed to be implicated in the development of arteriolar damage (AD). The aim of the present study was to explore the correlation between SUA levels, renal damage and its implication for outcome in IgAN patients.Methods and results: Clinical, laboratory and histologic data of 145 patients with biopsy proven IgAN were collected and retrospectively analyzed to determine the correlation between SUA levels, renal damage and the primary outcome (death or ESRD). Biopsy-proven AD was defined by the presence of arteriolar hyalinosis and/or intimal thickening.HU, defined as the highest SUA gender-specific tertile, was >7.7 mg/dl for males and >6.2 mg/ dl for females. The prevalence of AD increased with the increase in the SUA level tertiles (p = 0.02). At logistic regression analysis SUA was independently related to the presence of AD (OR 1.75 [95%CI 1.10-2.93], p = 0.03). HU and AD had a synergic impact on progression of IgAN. Patients having both AD and HU, showed a reduced survival free from the primary outcome as compared to those having only one risk factor or neither (p = 0.01).Conclusions: SUA levels are independently associated with AD and poor prognosis in patients with IgAN. (C) 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.