Should we manage asymptomatic hyperuricemia to protect the kidney?
PDF (Español)
xml (Español)

Keywords

Uric acid
Asymptomatic patient
Kidney damage
Nephroprotection
Allopurinol
Febuxostat

How to Cite

1.
Rubio-Guerra AF, Guerrero García C. Should we manage asymptomatic hyperuricemia to protect the kidney?. Rev. Colomb. Nefrol. [Internet]. 2023 Feb. 22 [cited 2024 Jun. 25];10(1). Available from: https://revistanefrologia.org/index.php/rcn/article/view/663

Abstract

Background: Uric acid is the end product of purine degradation in primates, under normal conditions it is an endogenous antioxidant agent and participates in several physiological pathways. However, when serum urate levels are increased, they participate in the development of various diseases.

Since the nineteenth century, the association between hyperuricemia and kidney damage has been known.

Although no management guideline recommends the use of hypouricemic drugs in asymptomatic patients, in some special cases pharmacological management will benefit patients with hyperuricemia, providing protection to the kidney and decreasing the risk of developing end-stage renal disease.

Purpose: To describe the relationship between hyperuricemia and kidney damage, and to analyze the cases in which the management of this condition with medications will result in a benefit for the kidney of patients.

Methodology: Review of the literature on the involvement of hyperuricemia in kidney damage, analysis of the reviewed articles.

Results: Management of asymptomatic hyperuricemia may protect the kidney in some specific situations.

Conclusions: There are specific situations for the decrease of serum uric acid levels.

https://doi.org/10.22265/acnef.10.1.663
PDF (Español)
xml (Español)

References

Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;15(213):8-14. https://doi.org/10.1016/j.ijcard.2015.08.109

Sánchez-Lozada LG, Rodríguez-Iturbe B, Kelley EE, Nakagawa T, Madero M, Feig DI, et al. Uric Acid and Hypertension: An Update with Recommendations. Am J Hypertens. 2020;33:583-594. https://doi.org/10.1093/ajh/hpaa044

Méndez Landa CE. Renal Effects of Hyperuricemia. Contrib Nephrol. 2018;192:8-16. https://doi.org/10.1159/000484273

Guerrero-García C, Rubio-Guerra AF. Hiperuricemia y síndrome metabólico. En Castro-Martínez MG, Rubio Guerra AF, editores. Diabetes y corazón. México: Editorial Alfil; 2021. p. 207-216.

Paul B, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene? Clin Rheumatol. 2017;36:2637-2644. https://doi.org/10.1007/s10067-017-3851-y

Rubio-Guerra AF, Morales-López H, Garro-Almendaro AK, et al. Circulating levels of uric acid and risk for metabolic syndrome. Curr Diabetes Rev. 2017;13:87-90. https://doi.org/10.2174/1573399812666150930122507

Sánchez-Lozada LG. The Pathophysiology of Uric Acid on Renal Diseases. Contrib Nephrol. 2018;192:17-24. https://doi.org/10.1159/000484274

Goldberg A, García-Arroyo F, Sasai F, Rodríguez-Iturbe B, Sánchez-Lozada LG, Lanaspa MA, et al. Mini Review: Reappraisal of Uric Acid in Chronic Kidney Disease. Am J Nephrol. 2021;52:837-844. https://doi.org/10.1159/000519491

Ejaz AA, Nakagawa T, Kanbay M, Kuwabara M, Kumar A, García Arroyo FE, et al. Hyperuricemia in Kidney Disease: A Major Risk Factor for Cardiovascular Events, Vascular Calcification, and Renal Damage. Semin Nephrol. 2020;40:574-585. https://doi.org/10.1016/j.semnephrol.2020.12.004

Stack AG, Johnson ME, Blak B, Klein A, Carpenter L, Morlock R, et al. Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study. BMJ Open. 2019;9:e031550. https://doi.org/10.1136/bmjopen-2019-031550

Chou YC, Kuan JC, Yang T, Chou W, Hsieh P, Bai C, et al. Elevated uric acid level as a significant predictor of chronic kidney disease: a cohort study with repeated measurements. J Nephrol. 2015;28:457-462. https://doi.org/10.1007/s40620-014-0158-9

Obermayr RP, Temml C, Gutjahr G, Knechtelsdorfer M, Oberbauer R, Klauser-Braun R. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol. 2008;19:2407-2413. https://doi.org/10.1681/ASN.2008010080

Borghi C, Agabiti-Rosei E, Johnson RJ, Kielstein J, Lurbe E, Mancia G, et al. Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease. Eur J Intern Med. 2020;80:1-11. https://doi.org/10.1016/j.ejim.2020.07.006

Sharaf El Din UA, Salem MM, Abdulazim DO. Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review. J Adv Res 2017;8: 537-548. https://doi.org/10.1016/j.jare.2016.11.004

Ejaz AA, Johnson RJ, Shimada M, Mohandas R, Alquadan KF, Beaver TM, et al. The Role of Uric Acid in Acute Kidney Injury. Nephron. 2019;142:275-283. https://doi.org/10.1159/000499939

Brucato A, Cianci F, Carnovale C. Management of hyperuricemia in asymptomatic patients: A critical appraisal. Eur J Intern Med. 2020;74:8-17. https://doi.org/10.1016/j.ejim.2020.01.001

Høieggen A, Alderman MH, Kjeldsen SE, Julius S, Devereux R, Faire U, et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int. 2004;65:1041-1049. https://doi.org/10.1111/j.1523-1755.2004.00484.x

Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout. JAMA. 2022;328:440-450. https://doi.org/10.1001/jama.2022.11390

Rubio-Guerra AF, Narváez-Rivera JL, Benítez-Maldonado DR, Guerrero-García C, Arana-Pazos KC, Vargas-Ayala G. Correlación entre niveles de ácido úrico y velocidad de la onda del pulso en sujetos con síndrome metabólico . Nefro Latinoam 2019;16:33-38. https://doi.org/10.24875/NEFRO.19000058

Chalès G. How should we manage asymptomatic hyperuricemia? Joint Bone Spine. 2019;86(4):437-443. https://doi.org/10.1016/j.jbspin.2018.10.004

Sato Y, Feig DI, Stack AG, Kang D, Lanaspa M, Ejaz A, et al. The case for uric acid-lowering treatment in patients with hyperuricaemia and CKD. Nat Rev Nephrol. 2019;15:767-775. https://doi.org/10.1038/s41581-019-0174-z

Johnson RJ, Bakris GL, Borghi C, Chonchol M, Feldman D, Lanaspa M, et al. Hyperuricemia, Acute and Chronic Kidney Disease, Hypertension, and Cardiovascular Disease: Report of a Scientific Workshop Organized by the National Kidney Foundation. Am J Kidney Dis. 2018;71:851-865. https://doi.org/10.1053/j.ajkd.2017.12.009

Vargas-Santos AB, Peloquin CE, Zhang Y, Neogi T. Association of Chronic Kidney Disease With Allopurinol Use in Gout Treatment. JAMA Intern Med. 2018;178:1526-1533. https://doi.org/10.1001/jamainternmed.2018.4463

Kohagura K, Tana T, Higa A, Yamazato M, Ishida A, Nagahama K, et al. Effects of xanthine oxidase inhibitors on renal function and blood pressure in hypertensive patients with hyperuricemia. Hypertens Res. 2016;39:593-597. https://doi.org/10.1038/hr.2016.37

Goicoechea M, Garcia de Vinuesa S, Verdalles U, Verde E, Macias N, Santos A, et al. Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial. Am J Kidney Dis. 2015;65:543-549. https://doi.org/10.1053/j.ajkd.2014.11.016

Eleftheriadis T, Golphinopoulos S, Pissas G, Stefanidis I. Asymptomatic hyperuricemia and chronic kidney disease: Narrative review of a treatment controversial. J Adv Res. 2017;8:555-560. https://doi.org/10.1016/j.jare.2017.05.001

Badve SV, Pascoe EM, Tiku A, Boudville N, Brown FG, Cass A, et al. Effects of Allopurinol on the Progression of Chronic Kidney Disease. N Engl J Med. 2020;382:2504-2513. https://doi.org/10.1056/NEJMoa1915833

Siu YP, Leung KT, Tong MK, Kwan TH. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis. 2006;47:51-59. https://doi.org/10.1053/j.ajkd.2005.10.006

Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med. 2016 jul. 28;375:323-34. https://doi.org/10.1056/NEJMoa1515920

Kao MP, Ang DS, Gandy SJ, et al. Allopurinol benefits left ventricular mass and endothelial dysfunction in chronic kidney disease. J Am Soc Nephrol. 2011;22:1382-1389. https://doi.org/10.1681/ASN.2010111185

Terawaki H, Nakayama M, Miyazawa E, Murata Y, Nakayama K, Matsushima M, et al. Effect of allopurinol on cardiovascular incidence among hypertensive nephropathy patients: the Gonryo study. Clin Exp Nephrol. 2013;17:549-553. https://doi.org/10.1007/s10157-012-0742-z

Ghang BZ, Lee JS, Choi J, Kim J, Yoo B. Increased risk of cardiovascular events and death in the initial phase after discontinuation of febuxostat or allopurinol: another story of the CARES trial. RMD Open. 2022;8:e001944. https://doi.org/10.1136/rmdopen-2021-001944

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Dimensions


PlumX


Downloads

Download data is not yet available.