Moriyama Takahito, Itabashi Mitsuyo, Takei Takashi, Kataoka Hiroshi, Sato Masayo, Shimizu Ari, Iwabuchi Yuko, Nishida Miki, Uchida Keiko, Nitta Kosaku
Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan,
J Nephrol. 2015 Aug;28(4):451-6. doi: 10.1007/s40620-014-0154-0. Epub 2014 Oct 30.
High uric acid level is a known risk factor for deterioration of renal function in chronic kidney disease (CKD), but its influence on the progression of IgA nephropathy (IgAN) remains unclear.
Adult IgAN patients (n = 611) were classified according to CKD stage. Renal survival rates and clinical and histological findings were compared between patients with high (H-UA) and normal (N-UA) uric acid levels in different CKD stages.
The proportion of patients with H-UA increased significantly with increasing CKD stage (stage G1, 12.3%; stage G2, 19.0%; stage G3a, 43.7%; stage G3b-4, 69.0%; P < 0.001). The 30-year renal survival rate was similar in patients with H-UA and N-UA in CKD stages G1, G2, and G3b-4, but was significantly lower in patients with H-UA than with N-UA in CKD stage G3a (24.7 vs. 51.9%; P = 0.0205). The clinical findings were similar in patients with H-UA and N-UA, but the interval from onset to biopsy differed between groups. The proportion of patients with global sclerosis was significantly higher in patients with H-UA than with N-UA in CKD stage G3a (33.3 vs. 11.4%; P = 0.0005), but the Oxford classifications were similar between groups. Multivariate Cox regression analysis identified H-UA (HR 1.36, 95% CI 1.07-1.72, P = 0.011) and a large amount of proteinuria (HR 1.38, 95% CI 1.09-1.74, P = 0.0084) as independent predictors of end-stage renal disease.
H-UA induced global glomerular sclerosis and accelerated the progression of IgAN in CKD stage G3a.
高尿酸水平是慢性肾脏病（CKD）肾功能恶化的已知危险因素，但其对IgA肾病（IgAN）进展的影响仍不明确。
将成年IgAN患者（n = 611）根据CKD分期进行分类。比较不同CKD分期中尿酸水平高（H-UA）和正常（N-UA）的患者的肾脏生存率以及临床和组织学表现。
H-UA患者的比例随CKD分期增加而显著升高（G1期，12.3%；G2期，19.0%；G3a期，43.7%；G3b-4期，69.0%；P < 0.001）。在CKD的G1、G2和G3b-4期，H-UA和N-UA患者的30年肾脏生存率相似，但在CKD的G3a期，H-UA患者的肾脏生存率显著低于N-UA患者（24.7%对51.9%；P = 0.0205）。H-UA和N-UA患者的临床表现相似，但两组从发病到活检的时间间隔不同。在CKD的G3a期，H-UA患者的全球硬化比例显著高于N-UA患者（33.3%对11.4%；P = 0.0005），但两组的牛津分类相似。多因素Cox回归分析确定H-UA（风险比1.36，95%置信区间1.07 - 1.72，P = 0.011）和大量蛋白尿（风险比1.38，95%置信区间1.09 - 1.74，P = 0.0084）是终末期肾病的独立预测因素。
H-UA可导致全球肾小球硬化，并加速CKD的G3a期IgAN的进展。
