Hyperuricaemia and chronic kidney disease

Abstract

Hyperuricemia is defined as serum uric acid values greater than 6 mg/dl and could occur either due to hyperproduction or as a result of reduced renal excretion, which exceeds gut compensation. In Italy, prevalence is around 12% of the general population and increases in renal disease up to 60%. Recent experimental studies demonstrated a role of uric acid in the development of arterial hypertension and systemic arteriosclerosis, with an increase in cardiovascular risk. It also appears from observational studies that high uric acid is an independent risk factor associated with de novo onset of chronic kidney disease after adjustment of main confounding variables. Hyperuricemic subjects treated with febuxostat, a selective inhibitor of xantino-oxidase, showed in RCTs a better control of hyperuricaemia in comparison with those receiving allopurinol. Moreover, observational studies indicate that urate lowering treatment could be helpful in reducing cardiovascular events as well as in slowing the progression of chronic kidney disease; randomized controlled studies, designed to assess as primary outcome the nephroprotective effect of urate lowering treatment, are in progress.

KEY WORDS: hyperuricaemia, urate lowering drugs, chronic kidney disease (CKD)

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EPIDEMIOLOGIA DELL’IPERURICEMIA

Si definisce iperuricemia il riscontro di valori di acido urico (UA) sierico >6 mg/dl; tale condizione può essere il risultato di un’iperproduzione o, più frequentemente, di un’inefficiente escrezione urinaria per ridotta secrezione a livello tubulare renale. Quando i livelli sierici di UA raggiungono il fisiologico limite di saturazione, si può osservare una precipitazione di cristalli di urato a carico delle articolazioni, fino alla comparsa in circa il 10% dei casi di un attacco gottoso (1).  

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