Kim Min Jeong, Hopfer Helmut, Mayr Michael
1 Klinik für Ambulante Innere Medizin und Medizinische Poliklinik, Universitätsspital Basel.
Ther Umsch. 2016;73(3):159-65. doi: 10.1024/0040-5930/a000773.
Different types of kidney disease are known to be associated with hyperuricemia. The underlying pathophysiologic mechanisms strongly vary, and different ways of therapeutic approach are therefore required. In tumor lysis syndrome, a rapid, excessive increase of serum uric acid level can cause an acute renal failure. For chronic urate nephropathy, on the other hand, constantly elevated serum uric acid level for a longer period seems to be important. Being still controversial as a disease entity however, the aetiology for putative chronic urate nephropathy might be in fact chronic lead intoxication, as suggested by quite an amount of association data. In terms of uric acid nephrolithiasis, the major risk factor is a urinary acidification defect with persistently acidic urine pH, and not necessarily hyperuricemia or hyperuricosuria. Evidence suggests that metabolic diseases with increased insulin resistance are strongly associated with urinary acidification defect. Patients with uric acid kidney stones should therefore be thoroughly evaluated for such metabolic diseases and in a positive case adequately treated.
已知不同类型的肾脏疾病与高尿酸血症有关。其潜在的病理生理机制差异很大，因此需要不同的治疗方法。在肿瘤溶解综合征中，血清尿酸水平迅速过度升高可导致急性肾衰竭。另一方面，对于慢性尿酸盐肾病，较长时间内血清尿酸水平持续升高似乎很重要。然而，作为一种疾病实体仍存在争议，大量关联数据表明，假定的慢性尿酸盐肾病的病因可能实际上是慢性铅中毒。就尿酸肾结石而言，主要危险因素是尿液酸化缺陷导致尿液pH值持续呈酸性，而不一定是高尿酸血症或高尿酸尿症。有证据表明，胰岛素抵抗增加的代谢性疾病与尿液酸化缺陷密切相关。因此，对于尿酸肾结石患者，应全面评估此类代谢性疾病，若确诊则应进行适当治疗。
