Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Pediatrics, Division of Nephrology, Rush University Medical left, 445 East North Water Street, Suite 1804, Chicago, IL, USA.
Pediatr Nephrol. 2018 Aug;33(8):1405-1409. doi: 10.1007/s00467-018-3943-1. Epub 2018 Mar 16.
Hyperuricemia is a leading risk factor for the development of chronic kidney disease (CKD). We hypothesized that lowering serum uric acid (SUA) with allopurinol in hyperuricemic children with CKD may reduce the risk of CKD progression.
A total of 70 children, aged 3-15 years, with elevated serum uric acid level (SUA) > 5.5 mg/dL and CKD stages 1-3 were prospectively randomized to receive allopurinol 5 mg/kg/day (study group, n = 38) or no treatment (control group, n = 32) for 4 months. The primary and secondary outcomes were changes in estimated glomerular filtration rate (eGFR) (> 10 mL/min/1.73m) and the SUA (> 1.0 mg/dL) from baseline values, respectively.
Baseline age, gender, blood pressure (BP), body mass index (BMI), SUA, high-sensitive C-reactive protein (hsCRP), and eGFR were similar in allopurinol and control subjects. Allopurinol treatment resulted in a decrease in SUA, a decrease in systolic and diastolic BP, a decrease in hsCRP, and an increase in eGFR compared with the baseline values (p < 0.05 for all). No significant difference was observed in the control hyperuricemic subjects. In multiple regression analysis after incorporating variables (age, gender, BMI, systolic and diastolic BP, CRP, and SUA), eGFR was independently related to SUA both before and after treatments (p = 0.03 vs. p = 0.02, respectively). All patients in the study group tolerated allopurinol, and there were no adverse reactions observed by physical examination or reported by patients.
Urate-lowering therapy with allopurinol, over a 4-month period, can improve renal function in children with CKD stages 1-3.
高尿酸血症是慢性肾脏病（CKD）发展的主要危险因素。我们假设在患有 CKD 的高尿酸血症儿童中使用别嘌醇降低血清尿酸（SUA）可能会降低 CKD 进展的风险。
共纳入 70 名年龄在 3-15 岁之间，血清尿酸水平升高（SUA）>5.5mg/dL 且 CKD 1-3 期的儿童，前瞻性随机分为别嘌醇 5mg/kg/天组（研究组，n=38）或不治疗组（对照组，n=32），治疗时间为 4 个月。主要和次要结局分别为肾小球滤过率估计值（eGFR）（>10mL/min/1.73m）和基线值的 SUA（>1.0mg/dL）变化。
别嘌醇和对照组的基线年龄、性别、血压（BP）、体重指数（BMI）、SUA、高敏 C 反应蛋白（hsCRP）和 eGFR 相似。与基线值相比，别嘌醇治疗后 SUA 降低、收缩压和舒张压降低、hsCRP 降低、eGFR 升高（所有 p<0.05）。对照组高尿酸血症患者无显著差异。在纳入变量（年龄、性别、BMI、收缩压和舒张压、CRP 和 SUA）的多变量回归分析中，eGFR 与治疗前后的 SUA 均独立相关（p=0.03 与 p=0.02）。研究组所有患者均耐受别嘌醇，体检未见不良反应，患者亦无不良反应报告。
在 4 个月的时间内，使用别嘌醇降低尿酸治疗可以改善 CKD 1-3 期儿童的肾功能。
