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中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 457 -462. doi: 10.3877/cma.j.issn.1674-0785.2019.06.011

所属专题: 文献

综述

高尿酸血症肾病的诊治进展
张璐1, 杨定位1,()   
  1. 1. 300211 天津市天津医院肾病内科
  • 收稿日期:2018-10-31 出版日期:2019-03-15
  • 通信作者: 杨定位
  • 基金资助:
    天津市自然科学基金项目(16JCYBJC25600)

Progress in diagnosis and treatment of hyperuricemic nephropathy

Lu Zhang1, Dingwei Yang1,()   

  1. 1. Department of Nephrology, Tianjin Hospital, Tianjin 300211, China
  • Received:2018-10-31 Published:2019-03-15
  • Corresponding author: Dingwei Yang
  • About author:
    Corresponding author: Yang Dingwei, Email:
引用本文:

张璐, 杨定位. 高尿酸血症肾病的诊治进展[J]. 中华临床医师杂志(电子版), 2019, 13(06): 457-462.

Lu Zhang, Dingwei Yang. Progress in diagnosis and treatment of hyperuricemic nephropathy[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(06): 457-462.

近年来人群平均血清尿酸水平及高尿酸血症的患病率逐渐升高,由于高尿酸血症发病隐匿,早期不易发现,一旦疾病进展可能导致不可逆性肾损伤,故需提高人群对本病的认识,争取早诊断、早治疗,并积极消除与血尿酸升高相关的代谢性危险因素。本文综述了高尿酸血症肾病的发病机制、临床特点及诊治进展,以提高对血尿酸水平的重视,为该病的防治提供依据。

In recent years, the average serum uric acid level and the prevalence of hyperuricemia in the general population have gradually increased. As the onset of hyperuricemia is hidden, it is difficult to detect early. Once the disease progresses, it may lead to irreversible renal injury. Therefore, it is necessary to raise the awareness of hyperuricemia, strive for early diagnosis and treatment, and actively treat metabolic risk factors related to the increase of serum uric acid. This article will review the pathogenesis, clinical characteristics, diagnosis, and treatment of hyperuricemic nephropathy, in order to emphasize the importance of serum uric acid level and provide a basis for the prevention and treatment of this condition.

1
Rho YH, Zhu Y, Choi HK. The Epidemiology of Uric Acid and Fructose [J]. Semin Nephrol, 2011, 31(5): 410-419.
2
中华医学会内分泌学分会. 高尿酸血症和痛风治疗的中国专家共识[J]. 中华内分泌代谢杂志, 2013, 29(11): 913-920.
3
Soltani Z, Rasheed K, Kapusta DR, et al. Potential Role of Uric Acid in Metabolic Syndrome, Hypertension, Kidney Injury, and Cardiovascular Diseases: Is It Time for Reappraisal? [J]. Curr Hypertens Rep, 2013, 15(3): 175-181.
4
Techatraisak K, Kongkaew T. The association of hyperuricemia and metabolic syndrome in Thai postmenopausal women [J]. Climacteric, 2017, 20(6): 552-557.
5
Liu PJ, Ma F, Lou HP, et al. Relationship between serum uric acid levels and metabolic syndrome in Chinese postmenopausal women [J]. Climacteric, 2014, 17(2): 148-154.
6
Li L, Yang C, Zhao Y, et al. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: a systematic review and meta-analysis based on observational cohort studies [J]. BMC Nephrol, 2014, 15(1): 122.
7
Xu X, Hu J, Song N, et al. Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis [J]. BMC Nephrol, 2017, 18(1): 27.
8
Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007–2008 [J]. Arthritis Rheum, 2011, 63(10): 3136-3141.
9
Liu H, Zhang XM, Wang YL, et al. Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling [J]. J Nephrol, 2014, 27(6): 653-658.
10
Rui L, Cheng H, Di W, et al. Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis [J]. Biomed Res Int, 2015, 2015(15, supplement): 1-12.
11
Benn CL, Dua P, Gurrell R, et al. Physiology of Hyperuricemia and Urate-Lowering Treatments [J]. Front Med (Lausanne), 2018, 5: 160.
12
B Á, Alonso-Valdivielso JL. Hyperuricemia and gout; the role of diet [J]. Nutr Hosp, 2014, 29(4): 760-770.
13
Fathallah-Shaykh SA, Cramer MT. Uric acid and the kidney [J]. Pediatr Nephrol, 2014, 29(6): 999-1008.
14
Johnson RJ, Nakagawa T, Sanchez-Lozada LG, et al. Sugar, uric acid, and the etiology of diabetes and obesity [J]. Diabetes, 2013, 62(10): 3307-3315.
15
Anzai N, Enomoto A, Endou H. Renal urate handling: Clinical relevance of recent advances [J]. Curr Rheumatol Rep, 2005, 7(3): 227-234.
16
黄胜华. 高尿酸血症及其肾损伤的研究进展 [J]. 医学研究生学报, 2010, 23(11): 1217-1221.
17
Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey [J]. Lancet, 2012, 379(9818): 815-822.
18
Khadka M, Pantha B, Karki L. Correlation of Uric Acid with Glomerular Filtration Rate in Chronic Kidney Disease [J]. JNMA J Nepal Med Assoc, 2018, 56(212): 724-727.
19
Zhu Y, Pandya BJ, Choi HK. Comorbidities of Gout and Hyperuricemia in the US General Population: NHANES 2007-2008 [J]. Am J Med, 2012, 125(7): 679-687.
20
Kim IY, Lee DW, Lee SB, et al. The role of uric acid in kidney fibrosis: experimental evidences for the causal relationship [J]. Biomed Res Int, 2014, 2014(2): 638732.
21
Filiopoulos V, Hadjiyannakos D, Vlassopoulos D. New insights into uric acid effects on the progression and prognosis of chronic kidney disease [J]. Ren Fail, 2012, 34(4): 510-520.
22
Chou YC, Kuan JC, Yang T, et al. Elevated uric acid level as a significant predictor of chronic kidney disease: a cohort study with repeated measurements [J]. J Nephrol, 2015, 28(4): 457-462.
23
鄂静,郑亚莉,曹丽, 等. 高尿酸血症引起慢性肾脏病的Meta分析 [J]. 宁夏医学杂志, 2015, 37(3): 229-231.
24
张淑艳. 高尿酸血症肾病的临床特点及诊断 [J]. 中国医师进修杂志, 2004(s1): 159-160.
25
李娟. 高尿酸血症肾病的临床表现与治疗现状 [J]. 临床合理用药杂志, 2012, 5(28): 120-121.
26
Kumari A, Dokwal S, Mittal P, et al. An Increase Incidence in Uric Acid Nephrolithiasis: Changing Patterns [J]. J Clin Diagn Res, 2016, 10(7): BC01-3.
27
Liebman SE, Taylor JG, Bushinsky DA. Uric acid nephrolithiasis [J]. Urol Clin North Am, 2007, 34(3): 335-346.
28
Abou-Elela A. Epidemiology, Pathophysiology And Management Of Uric Acid Urolithiasis: A Narrative Review [J]. J Adv Res, 2017, 8(5): 513-527.
29
Kunitoshi I, Chiho I, Kozen K. Changes in serum uric acid have a reciprocal effect on eGFR change: a 10-year follow-up study of community-based screening in Okinawa, Japan [J]. Hypertens Res, 2013, 36(7): 650-654.
30
Tomita M, Mizuno S, Yamanaka H, et al. Does hyperuricemia affect mortality? A prospective cohort study of Japanese male workers [J]. J Epidemiol, 2000, 10(6): 403-409.
31
Hisashi Y. Japanese guideline for the management of hyperuricemia and gout: second edition [J]. Nucleosides Nucleotides Nucleic Acids, 2011, 30(12): 1018-1029.
32
Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia [J]. Arthritis Care Res, 2012, 64(10): 1431-1446.
33
中国慢性肾脏病患者合并高尿酸血症诊治共识专家组. 中国慢性肾脏病患者合并高尿酸血症诊治专家共识 [J]. 中华肾脏病杂志, 2017, 33(6): 463-469.
34
Choi HK, Atkinson K, Karlson EW, et al. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men [J]. N Engl J Med, 2004, 350(11): 1093-1103.
35
Ma L, Wei L, Chen H, et al. Influence of urate-lowering therapies on renal handling of uric acid [J]. Clin Rheumatol, 2016, 35(1): 133-141.
36
Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis [J]. Arthritis Care Res (Hoboken), 2012, 64(10): 1447-1461.
37
Wichittra T, Thawinee J, Pei C, et al. Strong association between HLA-B*5801 and allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in a Thai population [J]. Pharmacogenet Genomics, 2009, 19(9): 704-709.
38
Stamp LK, Day RO, Yun J. Allopurinol hypersensitivity: investigating the cause and minimizing the risk [J]. Nat Rev Rheumatol, 2016, 12(4): 235-242.
39
Hosoya T, Kimura K, Itoh S, et al. The effect of febuxostat to prevent a further reduction in renal function of patients with hyperuricemia who have never had gout and are complicated by chronic kidney disease stage 3: study protocol for a multicenter randomized controlled study [J]. Trials, 2014, 15(1): 26.
40
何志红,易建伟,袁峰, 等. 非布司他治疗尿酸性肾病的临床疗效观察 [J]. 现代医院, 2016, 16(9): 1260-1262.
41
Liu CT, Chen CY, Hsu CY, et al. Risk of Febuxostat-Associated Myopathy in Patients with CKD [J]. Clin J Am Soc Nephrol, 2017, 12(5): 744-750.
42
White WB, Saag KG, Becker MA, et al. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout [J]. N Engl J Med, 2018, 378(13): 1200-1210.
43
Kawamorita Y, Shiraishi T, Tamura Y, et al. Renoprotective effect of topiroxostat via antioxidant activity in puromycin aminonucleoside nephrosis rats [J]. Physiol Rep, 2017, 5(15): e13358.
44
Mizukoshi T, Kato S, Ando M, et al. Renoprotective effects of topiroxostat for Hyperuricaemic patients with overt diabetic nephropathy study (ETUDE study): A prospective, randomized, multicentre clinical trial [J]. Nephrology (Carlton), 2018, 23(11): 1023-1030.
45
Mende C. Management of Chronic Kidney Disease: The Relationship Between Serum Uric Acid and Development of Nephropathy [J]. Adv Ther, 2015, 32(12): 1177-1191.
46
Ramasamy SN, Korb-Wells CS, Kannangara DRW, et al. Allopurinol hypersensitivity: a systematic review of all published cases, 1950-2012 [J]. Drug Saf, 2013, 36(10): 953-980.
47
Guttmann A, Krasnokutsky S, Pillinger MH, et al. Pegloticase in gout treatment-safety issues, latest evidence and clinical considerations [J]. Ther Adv Drug Saf, 2017, 8(12): 379-388.
48
Sundy JS, Baraf HSB, Yood RA, et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials [J]. JAMA, 2011, 306(7): 711-720.
49
Howard SC, Jones DP, Pui CH. Tumor Lysis Syndrome [J].N Engl J Med, 2014, 364(19): 1844-1854.
50
Yu F, Feifei W, Yakun L, et al. Losartan treatment for hypertensive patients with hyperuricaemia in Chinese population: a meta-analysis [J]. J Hypertens, 2015, 33(4): 681-689.
51
Li-Jun LI, Chen H, Ren JY, et al. Effects of micronized fenofibrate on lipid and uric acid metabolism in patients with hyperlipidemia [J]. Beijing Da Xue Xue Bao Yi Xue Ban, 2009, 41(5): 541-544.
52
Derosa G, Maffioli P, Reiner Ž, et al. Impact of Statin Therapy on Plasma Uric Acid Concentrations: A Systematic Review and Meta-Analysis [J]. Drugs, 2016, 76(9): 947-956.
53
Ma Z, Long L, Liu J, et al. Montmorillonite adsorbs uric acid and increases the excretion of uric acid from the intestinal tract in mice [J]. J Pharm Pharmacol, 2009, 61(11): 1499-1504.
54
Ohno I, Yamaguchi Y, Saikawa H, et al. Sevelamer Decreases Serum Uric Acid Concentration through Adsorption of Uric Acid in Maintenance Hemodialysis Patients [J]. Intern Med, 2009, 48(6): 415-420.
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