Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Nephrology, The People's Hospital of Chengyang, Qingdao, Shandong, China.
Clin Exp Rheumatol. 2024 Jan;42(1):30-38. doi: 10.55563/clinexprheumatol/ar7nsq. Epub 2023 Nov 28.
Increased serum uric acid (SUA) levels are well known to be concomitant of cardiovascular and kidney diseases, and have been proposed to be implicated in the development of arteriolar damage. The aim of the present study was to assess the association between SUA levels, renal damage and its implication for outcome in patients with lupus nephritis (LN).
This retrospective study included 194 cases with biopsy proven LN at the Affiliated Hospital of Qingdao University between January 2013 and June 2021. We reviewed clinical, laboratory and histologic data of patients and analysed the correlation between SUA levels, renal damage and the primary outcome (death or ESRD). Biopsy-proven arteriolar damage was defined by the presence of arteriolar hyalinosis and/or intimal thickening.
Compared to LN patients without hyperuricemia, LN patients with hyperuricaemia presented with higher BP, hyperlipidaemia, lower eGFR, lower haemoglobin, lower serum albumin, worse renal arteriolar damage and proteinuria, and also higher SLEDAI score, activity index and chronicity index (p<0.05). At logistic regression analysis, SUA was independently related to the presence of arteriolar damage. For each 100 μmol/L increase in SUA levels the risk for arteriolar damage raised by 53.8% (hazard ratio [HR] =1.538; 95% CI: 1.147-2.063; p=0.004) after adjustment for haemoglobin, serum creatinine and erythrocyte sedimentation rate. Cox regression analysis showed that female (HR=3.180; 95% CI: 1.216-8.313; p=0.018), white blood cell count (HR=1.111; 95% CI: 1.027-1.202; p=0.009), SUA (HR=1.100; 95% CI: 1.023-1.253; p=0.035), serum creatinine (HR=1.800; 95% CI: 1.348-2.404; p<0.001), and renal arteriolar damage (HR=3.117; 95% CI: 1.022-9.511; p=0.046) was significantly associated with development of ESRD or death in patients with LN after adjustment for several potential confounding factors. Furthermore, for each 100 μmol/L increase in SUA levels, the risk of ESRD or death increased by 10%.
SUA levels are directly associated with renal arteriolar damage and poor prognosis in LN patients. Hyperuricaemia is an important predictor for poor prognosis in patients with LN.
血清尿酸（SUA）水平升高与心血管和肾脏疾病密切相关，并且与小动脉损伤的发展有关。本研究旨在评估 SUA 水平与狼疮性肾炎（LN）患者的肾脏损伤及其对预后的影响之间的关系。
这项回顾性研究纳入了 2013 年 1 月至 2021 年 6 月在青岛大学附属医院经活检证实的 194 例 LN 患者。我们回顾了患者的临床、实验室和组织学数据，并分析了 SUA 水平、肾脏损伤与主要结局（死亡或终末期肾病）之间的相关性。活检证实的小动脉损伤定义为小动脉玻璃样变性和/或内膜增厚。
与无高尿酸血症的 LN 患者相比，高尿酸血症的 LN 患者血压更高、血脂异常、估算肾小球滤过率（eGFR）更低、血红蛋白更低、血清白蛋白更低、肾脏小动脉损伤和蛋白尿更严重，且 SLEDAI 评分、活动指数和慢性指数更高（p<0.05）。在逻辑回归分析中，SUA 与小动脉损伤的存在独立相关。SUA 水平每增加 100 μmol/L，小动脉损伤的风险增加 53.8%（风险比 [HR] =1.538；95%CI：1.147-2.063；p=0.004），校正血红蛋白、血清肌酐和红细胞沉降率后。Cox 回归分析显示，女性（HR=3.180；95%CI：1.216-8.313；p=0.018）、白细胞计数（HR=1.111；95%CI：1.027-1.202；p=0.009）、SUA（HR=1.100；95%CI：1.023-1.253；p=0.035）、血清肌酐（HR=1.800；95%CI：1.348-2.404；p<0.001）和肾脏小动脉损伤（HR=3.117；95%CI：1.022-9.511；p=0.046）与 LN 患者发生 ESRD 或死亡的风险显著相关，校正了几个潜在的混杂因素。此外，SUA 水平每增加 100 μmol/L，ESRD 或死亡的风险增加 10%。
SUA 水平与 LN 患者的肾脏小动脉损伤和预后不良直接相关。高尿酸血症是 LN 患者预后不良的重要预测因素。
