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Review
. 2015 May 23;7(3):e27233.
doi: 10.5812/numonthly.7(3)2015.27233. eCollection 2015 May.

Associations Between Hyperuricemia and Chronic Kidney Disease: A Review

Om Shankar Prasad Sah  1 , Yu Xue Qing  1
Affiliations
Review

Associations Between Hyperuricemia and Chronic Kidney Disease: A Review

Om Shankar Prasad Sah et al. Nephrourol Mon. .

Abstract

Context: 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).

Evidence acquisition: 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 m(2) 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.

Results: 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.

Conclusions: 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.

Keywords: Allopurinol Therapy; Glomerular Filtration Rate; Hyperuricemia; Renal Insufficiency, Chronic; Uric Acid.

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Figures

Figure 1.
Figure 1.. Schematic Representation of Uric Acid Homeostasis
Figure 2.
Figure 2.. Putative Mechanisms by Which Elevated Serum Uric Acid Levels May Contribute to Chronic Kidney Disease Development and Progression
See this image and copyright information in PMC

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