Division of Nephrology, Department of Internal Medicine, Kyung Hee University, College of Medicine, Seoul, Republic of Korea.
Am J Physiol Renal Physiol. 2020 Jun 1;318(6):F1327-F1340. doi: 10.1152/ajprenal.00272.2019. Epub 2020 Mar 30.
Asymptomatic hyperuricemia is frequently observed in patients with kidney disease. Although a substantial number of epidemiologic studies have suggested that an elevated uric acid level plays a causative role in the development and progression of kidney disease, whether hyperuricemia is simply a result of decreased renal excretion of uric acid or is a contributor to kidney disease remains a matter of debate. Over the last two decades, multiple experimental studies have expanded the knowledge of the biological effects of uric acid beyond its role in gout. In particular, uric acid induces immune system activation and alters the characteristics of resident kidney cells, such as tubular epithelial cells, endothelial cells, and vascular smooth muscle cells, toward a proinflammatory and profibrotic state. These findings have led to an increased awareness of uric acid as a potential and modifiable risk factor in kidney disease. Here, we discuss the effects of uric acid on the immune system and subsequently review the effects of uric acid on the kidneys mainly in the context of inflammation.
无症状高尿酸血症在肾病患者中经常观察到。尽管大量的流行病学研究表明，尿酸水平升高在肾脏病的发生和进展中起因果作用，但高尿酸血症是仅仅是由于肾脏尿酸排泄减少的结果，还是导致肾脏病的原因，这仍然存在争议。在过去的二十年中，多项实验研究已经将尿酸的生物学作用扩展到了痛风以外的领域。特别是，尿酸诱导免疫系统的激活，并改变了固有肾细胞的特征，如肾小管上皮细胞、内皮细胞和血管平滑肌细胞，使其向促炎和促纤维化状态发展。这些发现使人们越来越意识到尿酸是肾脏病的一个潜在的、可改变的危险因素。在这里，我们讨论了尿酸对免疫系统的影响，然后主要在炎症的背景下综述了尿酸对肾脏的影响。
