Ohashi Naro, Ishigaki Sayaka, Isobe Shinsuke, Tsuji Naoko, Iwakura Takamasa, Ono Masafumi, Tsuji Takayuki, Sakao Yukitoshi, Kato Akihiko, Yasuda Hideo
Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Blood Purification Unit, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Nephrology (Carlton). 2015 Nov;20(11):814-9. doi: 10.1111/nep.12504.
Both hyperuricaemia and activation of the intrarenal renin-angiotensin system (RAS) play an important role in the development of hypertension and renal damage. However, it has not been clear whether hyperuricaemia is associated with renal damage due to hypertension or intrarenal RAS activation, as well as their circadian rhythms.
We recruited 43 chronic kidney disease (CKD) patients who did not receive RAS blockers and antihyperuricaemic drugs, and investigated the relationship among serum uric acid (sUA) levels, the circadian rhythm of urinary angiotensinogen (U-AGT) excretion levels, and the levels of albuminuria (U-ACR) and proteinuria (U-P/Cr).
sUA levels were significantly associated with estimated glomerular filtration rate (eGFR) (P = 0.002), systolic blood pressure (SBP) (daytime, P = 0.031), and U-ACR (daytime, P = 0.006 and nighttime, P = 0.008) and U-P/Cr (daytime, P = 0.017 and nighttime, P = 0.013). However, there were no significant differences between sUA levels and SBP in nighttime and U-AGT excretion levels in both time periods. Multiple regression analyses for sUA levels were performed using age, sex, eGFR and each parameter (SBP, U-AGT/Cr, U-ACR or U-P/Cr). sUA levels were not associated with SBP or U-AGT/Cr in both time periods. sUA levels tended to correlate with U-P/Cr levels in nighttime, and were significantly associated with U-P/Cr in daytime (P = 0.026) and U-ACR in daytime (P = 0.017) and nighttime (P = 0.046). Moreover, no significant differences were found between sUA levels and night-to-day ratios of some parameters.
These data suggest that hyperuricaemia is associated with renal damage, independently of hypertension and intrarenal RAS activation, as well as their circadian rhythms.
高尿酸血症和肾内肾素-血管紧张素系统（RAS）激活在高血压和肾损害的发生发展中均起重要作用。然而，高尿酸血症是否与高血压或肾内RAS激活所致的肾损害及其昼夜节律相关尚不清楚。
我们招募了43例未接受RAS阻滞剂和抗高尿酸血症药物的慢性肾脏病（CKD）患者，研究血清尿酸（sUA）水平、尿血管紧张素原（U-AGT）排泄水平的昼夜节律与尿白蛋白肌酐比值（U-ACR）和尿蛋白肌酐比值（U-P/Cr）水平之间的关系。
sUA水平与估计肾小球滤过率（eGFR）（P = 0.002）、收缩压（SBP）（日间，P = 0.031）、U-ACR（日间，P = 0.006，夜间，P = 0.008）及U-P/Cr（日间，P = 0.017，夜间，P = 0.013）显著相关。然而，夜间sUA水平与SBP以及两个时间段的U-AGT排泄水平之间均无显著差异。使用年龄、性别、eGFR和各参数（SBP、U-AGT/Cr、U-ACR或U-P/Cr）对sUA水平进行多元回归分析。两个时间段的sUA水平均与SBP或U-AGT/Cr无关。sUA水平在夜间与U-P/Cr水平呈趋势性相关，在日间与U-P/Cr（P = 0.026）、日间U-ACR（P = 0.017）及夜间U-ACR（P = 0.046）显著相关。此外，sUA水平与某些参数的夜间/日间比值之间未发现显著差异。
这些数据表明，高尿酸血症与肾损害相关，独立于高血压和肾内RAS激活及其昼夜节律。
