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Clinical and Experimental Nephrology
Published in: Clinical and Experimental Nephrology 2/2017

01-04-2017 | Review article

Time to target uric acid to retard CKD progression

Authors: Takanori Kumagai, Tatsuru Ota, Yoshifuru Tamura, Wen Xiu Chang, Shigeru Shibata, Shunya Uchida

Published in: Clinical and Experimental Nephrology | Issue 2/2017

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Abstract

Uric acid (UA) remains a possible risk factor of chronic kidney disease (CKD) but its potential role should be elucidated given a fact that multidisciplinary treatments assure a sole strategy to inhibit the progression to end-stage renal disease (ESRD). In clinical setting, most observational studies showed that elevation of serum uric acid (SUA) independently predicts the incidence and the development of CKD. The meta-analysis showed that SUA-lowering therapy with allopurinol may retard the progression of CKD but did not reach conclusive results due to small-sized studies. Larger scale, randomized placebo-controlled trials to assess SUA-lowering therapy are needed. Our recent analysis by propensity score methods has shown that the threshold of SUA should be less than 6.5 mg/dL to abrogate ESRD. In animal models an increase in SUA by the administration of oxonic acid, uricase inhibitor, or nephrectomy can induce glomerular hypertension, arteriolosclerosis including afferent arteriolopathy and tubulointerstitial fibrosis. The ever-growing discoveries of urate transporters prompt us to learn UA metabolism in the kidney and intestine. One example is that the intestinal ABCG2 may play a compensatory role at face of decreased renal clearance of UA in nephrectomized rats, the trigger of which is not a uremic toxin but SUA itself. This review will summarize the recent knowledge on the relationship between SUA and the kidney and try to draw a conclusion when and how to treat asymptomatic hyperuricemia accompanied by CKD. Finally we will address a future perspective on UA study including a Mendelian randomization approach.
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Metadata
Title
Time to target uric acid to retard CKD progression
Authors
Takanori Kumagai
Tatsuru Ota
Yoshifuru Tamura
Wen Xiu Chang
Shigeru Shibata
Shunya Uchida
Publication date
01-04-2017
Publisher
Springer Japan
Published in
Clinical and Experimental Nephrology / Issue 2/2017
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-016-1288-2

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Effectiveness of N-acetylcysteine for preserving residual renal function in patients undergoing maintenance hemodialysis: multicenter randomized clinical trial

Original Article

Mutation profile and treatment of Gitelman syndrome in Chinese patients

Original Article

Oxidative stress markers in type 2 diabetes patients with diabetic nephropathy

Original Article

Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method

Original article

Double inhibition of cAMP and mTOR signalling may potentiate the reduction of cell growth in ADPKD cells

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

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