Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Int Urol Nephrol. 2021 Nov;53(11):2321-2332. doi: 10.1007/s11255-021-02844-4. Epub 2021 Apr 24.
Hyperuricemia (HUA) and hypertriglyceridemia (HTG) were very common in chronic kidney disease (CKD) and associated with accelerated progression of CKD. This was a retrospective, cross-sectional study which aimed to explore the relationship between serum uric acid levels or triglyceride levels and tubular atrophy/interstitial fibrosis (proven by renal biopsy).
The present study enrolled 229 CKD individuals who included 127 biopsy-proven primary IgA nephrology (IgAN) patients and 102 biopsy-proven primary membranous nephropathy (MN) patients. The baseline characteristics at the time of the kidney biopsy were collected. According to the serum uric acid (UA) or triglyceride (TG) whether it exceeds the normal reference range, patients were divided into non-HUA (n = 127), HUA (n = 102), non-HTG (n = 119), and HTG group (n = 110). Based on the extent of tubular atrophy/interstitial fibrosis, patients were divided into no/mild injury (T0, n = 127), moderate injury (T1, n = 102). Multivariable logistic regression for factors predicting moderate tubular atrophy/interstitial fibrosis was performed.
There were 127 IgAN and 102 MN cases among 229 patients in the present study. The prevalence of HUA was 44.5% (n = 102), 40.9% (n = 52), and 49.0% (n = 50) in all patients, IgAN patients and MN patients, respectively (P = 1.49). The prevalence of HTG was 48.0% (n = 110), 29.9% (n = 38), and 70.6% (n = 72) (P < 0.001), respectively, as well. Multivariate logistic regression analysis showed that HUA and HTG were independent risk factors for moderate tubular atrophy/interstitial fibrosis (HUA OR = 2.335, 95% CI = 1.147-4.755, P = 0.019; HTG OR = 2.646, 95% CI = 1.289-5.432, P = 0.008). The area under curve (AUC) of model 1 (HUA + eGFR + HTG + age + serum globulin + 24 h urinary protein, AUC = 0.876) was larger than the other two models; however, there was no significant difference among these models (all P > 0.05).
Hyperuricemia and hypertriglyceridemia, which were prevalent in CKD patients, were the independent risk factors for moderate tubular atrophy/interstitial fibrosis. HUA together with HTG could improve the value of diagnosis for moderate tubular atrophy/interstitial fibrosis to some extent.
高尿酸血症（HUA）和高三酰甘油血症（HTG）在慢性肾脏病（CKD）中非常常见，并与 CKD 的加速进展有关。本研究为回顾性、横断面研究，旨在探讨血清尿酸水平或甘油三酯水平与肾小管萎缩/间质纤维化（通过肾活检证实）之间的关系。
本研究纳入了 229 例 CKD 患者，其中包括 127 例经活检证实的原发性 IgA 肾病（IgAN）患者和 102 例经活检证实的原发性膜性肾病（MN）患者。收集了肾活检时的基线特征。根据血清尿酸（UA）或甘油三酯（TG）是否超过正常参考范围，将患者分为非高尿酸血症（n=127）、高尿酸血症（n=102）、非高三酰甘油血症（n=119）和高三酰甘油血症组（n=110）。根据肾小管萎缩/间质纤维化的程度，患者被分为无/轻度损伤（T0，n=127）和中度损伤（T1，n=102）。对中度肾小管萎缩/间质纤维化的预测因素进行多变量逻辑回归分析。
本研究中 229 例患者中，IgAN 患者 127 例，MN 患者 102 例。高尿酸血症在所有患者、IgAN 患者和 MN 患者中的患病率分别为 44.5%（n=102）、40.9%（n=52）和 49.0%（n=50）（P=1.49）。高三酰甘油血症的患病率分别为 48.0%（n=110）、29.9%（n=38）和 70.6%（n=72）（P<0.001）。多变量逻辑回归分析显示，高尿酸血症和高三酰甘油血症是中度肾小管萎缩/间质纤维化的独立危险因素（高尿酸血症 OR=2.335，95%CI=1.147-4.755，P=0.019；高三酰甘油血症 OR=2.646，95%CI=1.289-5.432，P=0.008）。模型 1（HUA+eGFR+HTG+年龄+血清球蛋白+24 小时尿蛋白，AUC=0.876）的曲线下面积（AUC）大于其他两个模型；然而，这些模型之间没有显著差异（均 P>0.05）。
高尿酸血症和高三酰甘油血症在 CKD 患者中很常见，是中度肾小管萎缩/间质纤维化的独立危险因素。高尿酸血症与高三酰甘油血症联合使用可在一定程度上提高对中度肾小管萎缩/间质纤维化的诊断价值。
