慢性肾脏病患者高尿酸血症的管理

Management of hyperuricemia in patients with chronic kidney disease

生理情况下,人体每日尿酸的产生和排泄基本上保持动态平衡。若血清尿酸水平男>420μmol/L,女>360μmol/L则称为高尿酸血症。随着居民生活方式、饮食结构的改变以及人口老龄化,高尿酸血症的发病率呈逐年上升趋势。越来越多的研究表明高尿酸血症与慢性肾脏病(CKD)的关系密切。尿酸是嘌呤核苷酸代谢中不易溶解的循环终产物,CKD患者肾小球滤过率降低时,高尿酸血症发生的风险增加,而长期的高尿酸血症会导致肾功能的进行性恶化,增加患者心血管疾病的发生风险及死亡率。因此做好CKD患者高尿酸血症的管理具有重要的临床意义。关于高尿酸血症诊断和治疗有多项专家共识和指南,即改善生活方式是治疗的基础,早期干预和综合管理是治疗的核心。

Under the physiological condition,human daily production and excretion of uric acid are maintained basically at a dynamic balance. When serum uric acid level is higher than 420 μmol / L in men or 360 μmol / L in women,there is hyperuricemia. With the change of life style,diet structure,and increase of aging population,the incidence of hyperuricemia is increasing year by year. Recently more and more researches have indicated that hyperuricemia is closely related to chronic kidney disease（CKD）. Uric acid is the poorly soluble circulating end product of the purine nucleotide metabolism. A reduction in the glomerular filtration rate（GFR） contributes to hyperuricemia. Long-term hyperuricemia can lead to progressive deterioration of renal function,increasing the risk of cardiovascular disease in patients with increased mortality. It is important to investigate the management for CKD patients with hyperuricemia.There are expert consensus and guidelines for diagnosis and treatment of the hyperuricemia. The basis of treatment is improving the life style,and the core of treatment are early intervention and comprehensive management.