Division of Nephrology, Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, Korea.
Semin Nephrol. 2011 Sep;31(5):447-52. doi: 10.1016/j.semnephrol.2011.08.009.
Although an elevation of serum uric acid level is often associated with chronic kidney disease (CKD), it remains controversial whether hyperuricemia per se is a true risk factor for the development or aggravation of CKD. Recent epidemiologic studies in healthy populations or in subjects with established kidney disease have reported the independent role of uric acid in lowering glomerular filtration rate and increasing the risk for new-onset kidney disease. Furthermore, lowering uric acid in patients with established renal disease has been reported to stabilize renal function independent of other confounders, suggesting a causative role of elevated uric acid in progression of CKD, rather than as an incidental finding related to CKD severity. In this manuscript we will discuss the potential role of uric acid in the development and aggravation of CKD based on epidemiologic, clinical and experimental studies. Given the worldwide epidemic of CKD, the importance of identifying modifiable risk factors of CKD, and the clinical implication of hyperuricemia in CKD, we propose large randomized clinical trials to investigate whether uric acid-lowering therapy can slow the progression of CKD.
虽然血清尿酸水平升高通常与慢性肾脏病（CKD）有关，但高尿酸血症本身是否是 CKD 发生或加重的真正危险因素仍存在争议。最近在健康人群或已确诊肾脏疾病患者中的流行病学研究报告了尿酸在降低肾小球滤过率和增加新发肾脏疾病风险方面的独立作用。此外，在已确诊肾脏疾病的患者中降低尿酸已被报道可稳定肾功能，而与其他混杂因素无关，这表明尿酸升高在 CKD 进展中起因果作用，而不是与 CKD 严重程度相关的偶然发现。在本文中，我们将根据流行病学、临床和实验研究讨论尿酸在 CKD 发生和加重中的潜在作用。鉴于 CKD 在全球的流行，确定 CKD 可改变的危险因素的重要性以及高尿酸血症在 CKD 中的临床意义，我们建议进行大型随机临床试验，以研究降低尿酸治疗是否可以减缓 CKD 的进展。
