Konta Tsuneo, Kamei Keita, Ichikawa Kazunobu, Kayama Takamasa, Kubota Isao
Contrib Nephrol. 2018;192:34-40. doi: 10.1159/000484276. Epub 2018 Jan 23.
Hyperuricemia is a risk factor for causing end-stage kidney disease and cardiovascular disease in the general population; however, several aspects, such as the site of kidney damaged by hyperuricemia and the threshold levels of serum uric acid for the development of renal damage, have not been fully clarified.
To examine these aspects, we analyzed data from the Takahata study, a community-based cohort study involving participants of an annual health check-up, and used urinary albumin creatinine ratio (UACR) and urinary β2-microglobulin creatinine ratio (UBCR) in spot urine as indices of glomerular and tubular damage respectively. In cross-sectional analysis, increased serum uric acid levels were accompanied by higher UACR values and lower UBCR values. Multivariate analysis revealed that albuminuria (UACR ≥30 mg/g), but not elevated UBCR, was independently associated with increased uric acid (≥7 mg/dL for males, ≥6 mg/dL for females). In longitudinal analysis, uric acid at baseline was an independent factor for a 1-year increase in the UACR. Cox-proportional hazard model analysis with adjustment for possible confounders including age, renal function, and comorbidities revealed that hyperuricemia was an independent risk factor for all-cause and cardiovascular mortality in females. Key Messages: Our results revealed that elevated uric acid is an independent risk factor for glomerular damage, but not tubular damage, and that the risk for renal damage and mortality might be increased at the high-normal range of uric acid in the community-based population.
高尿酸血症是普通人群发生终末期肾病和心血管疾病的危险因素；然而，高尿酸血症导致肾脏损伤的部位以及发生肾损伤的血清尿酸阈值等几个方面尚未完全阐明。
为研究这些方面，我们分析了高幡研究的数据，这是一项基于社区的队列研究，参与者为年度健康体检者，并分别将随机尿中的尿白蛋白肌酐比值（UACR）和尿β2-微球蛋白肌酐比值（UBCR）用作肾小球和肾小管损伤的指标。在横断面分析中，血清尿酸水平升高伴随着较高的UACR值和较低的UBCR值。多变量分析显示，蛋白尿（UACR≥30mg/g）而非升高的UBCR与尿酸升高（男性≥7mg/dL，女性≥6mg/dL）独立相关。在纵向分析中，基线尿酸是UACR一年增加的独立因素。对包括年龄、肾功能和合并症等可能的混杂因素进行调整后的Cox比例风险模型分析显示，高尿酸血症是女性全因死亡和心血管死亡的独立危险因素。关键信息：我们的结果显示，尿酸升高是肾小球损伤而非肾小管损伤的独立危险因素，并且在社区人群中，尿酸处于高正常范围时，肾损伤和死亡风险可能会增加。
