Tanaka Yoshimi, Hatakeyama Shingo, Tanaka Toshikazu, Yamamoto Hayato, Narita Takuma, Hamano Itsuto, Matsumoto Teppei, Soma Osamu, Okamoto Teppei, Tobisawa Yuki, Yoneyama Tohru, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Takahashi Ippei, Nakaji Shigeyuki, Terayama Yuriko, Funyu Tomihisa, Ohyama Chikara
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
PLoS One. 2017 Jul 31;12(7):e0182136. doi: 10.1371/journal.pone.0182136. eCollection 2017.
To determine the influence of serum uric acid (UA) levels on renal impairment in patients with UA stone.
We retrospectively analyzed 463 patients with calcium oxalate and/or calcium phosphate stones (CaOx/CaP), and 139 patients with UA stones. The subjects were divided into the serum UA-high (UA ≥ 7.0 mg/dL) or the UA-low group (UA < 7.0 mg/dL). The control group comprised 3082 community-dwelling individuals that were pair-matched according to age, sex, body mass index, comorbidities, hemoglobin, serum albumin, and serum UA using propensity score matching. We compared renal function between controls and patients with UA stone (analysis 1), and between patients with CaOx/CaP and with UA stone (analysis 2). Logistic regression analysis was used to evaluate the impact of the hyperuricemia on the development of stage 3 and 3B chronic kidney disease (CKD) (analysis 3).
The renal function was significantly associated with serum UA levels in the controls and patients with CaOx/CaP and UA stones. In pair-matched subgroups, patients with UA stone had significantly lower renal function than the control subjects (analysis 1) and patients with CaOx/CaP stones (analysis 2) regardless of hyperuricemia. Multivariate logistic regression analysis revealed that patients with UA stone, CaOx/CaP, hyperuricemia, presence of cardiovascular disease, higher body mass index, older age and lower hemoglobin had significantly higher risk of stage 3 and 3B CKD (analysis 3).
Patients with UA stones had significantly worse renal function than controls and CaOx/CaP patients regardless of hyperuricemia. Urolithiasis (CaOx/CaP and UA stone) and hyperuricemia had an association with impaired renal function. Our findings encourage clinicians to initiate intensive treatment and education approaches in patients with urolithiasis and/or hyperuricemia in order to prevent the progression of renal impairment.
确定血清尿酸（UA）水平对尿酸结石患者肾功能损害的影响。
我们回顾性分析了463例草酸钙和/或磷酸钙结石（CaOx/CaP）患者以及139例尿酸结石患者。将受试者分为血清尿酸高（UA≥7.0mg/dL）组或尿酸低组（UA<7.0mg/dL）。对照组包括3082名社区居民，采用倾向得分匹配法根据年龄、性别、体重指数、合并症、血红蛋白、血清白蛋白和血清尿酸进行配对。我们比较了对照组与尿酸结石患者之间的肾功能（分析1），以及CaOx/CaP结石患者与尿酸结石患者之间的肾功能（分析2）。采用逻辑回归分析评估高尿酸血症对3期和3B期慢性肾脏病（CKD）发生发展的影响（分析3）。
在对照组、CaOx/CaP结石患者和尿酸结石患者中，肾功能与血清尿酸水平显著相关。在配对亚组中，无论是否存在高尿酸血症，尿酸结石患者的肾功能均显著低于对照组（分析1）和CaOx/CaP结石患者（分析2）。多因素逻辑回归分析显示，尿酸结石患者、CaOx/CaP结石患者、高尿酸血症患者、存在心血管疾病患者、较高的体重指数、较高的年龄和较低的血红蛋白患者发生3期和3B期CKD的风险显著更高（分析3）。
无论是否存在高尿酸血症，尿酸结石患者的肾功能均显著差于对照组和CaOx/CaP结石患者。尿路结石（CaOx/CaP和尿酸结石）和高尿酸血症与肾功能损害有关。我们的研究结果鼓励临床医生对尿路结石和/或高尿酸血症患者采取强化治疗和教育措施，以预防肾功能损害的进展。
