Association between Serum Uric Acid and the Early Marker of Kidney Function Decline among Chinese Middle-Aged and Older Population:Evidence from the China Health and Retirement Longitudinal Study

Objective To evaluate the association between serum uric acid(SUA)and kidney function decline.Methods Data was obtained from the China Health and Retirement Longitudinal Study on the Chinese middle-aged and older population for analysis.The kidney function decline was defined as an annual estimated glomerular filtration rate(e GFR)decrease by>3 mL/min per 1.73 m^(2).Multivariable logistic regression was applied to determine the association between SUA and kidney function decline.The shape of the association was investigated by restricted cubic splines.Results A total of 7,346 participants were included,of which 1,004 individuals(13.67%)developed kidney function decline during the follow-up of 4 years.A significant dose-response relation was recorded between SUA and the kidney function decline(OR 1.14,95%CI 1.03-1.27),as the risk of kidney function decline increased by 14%per 1 mg/d L increase in SUA.In the subgroup analyses,such a relation was only recorded among women(OR 1.22,95%CI 1.03-1.45),those aged<60 years(OR 1.22,95%CI 1.05-1.42),and those without hypertension and without diabetes(OR 1.22,95%CI 1.06-1.41).Although the dose-response relation was not observed in men,the high level of SUA was related to kidney function decline(OR 1.83,95%CI 1.05-3.17).The restricted cubic spline analysis indicated that SUA>5 mg/dL was associated with a significantly higher risk of kidney function decline.Conclusion The SUA level was associated with kidney function decline.An elevation of SUA should therefore be addressed to prevent possible kidney impairment and dysfunction.

Uric acid and chronic kidney disease: A time to act?

A role for uric acid in the pathogenesis and progression of renal disease had been proposed almost a century ago, but, too hastily dismissed in the early eighties. A body of evidence, mostly accumulated during the last decade, has led to a reappraisal of the infuence of uric acid on hypertension, cardiovascular, and renal disease. The focus of this review will be solely on the relationship between serum uric acid and renal function and disease. We will review experimental evidence derived from ani-mal and human studies, evidence gathered from a num-ber of epidemiological studies, and from the few （up to now） studies of uric-acid-lowering therapy. Some space will be also devoted to the effects of uric acid in special populations, such as diabetics and recipients of kidney allografts. Finally we will briefy discuss the challenges of a trial of uric-acid-lowering treatment, and the recent suggestions on how to conduct such a trial.

Regulating and tonifying spleen and kidney traditional Chinese medicine in the treatment of chronic uric acid nephropathy: A systematic review

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine for regulating spleen and kidney.Methods:We developed a search strategy and then retrieved the database including CNKI,Wanfang data knowledge service platform,VIP journals resource integration service platform,PubMed,Embasefor randomized controlled trial of regulating spleen and kidney traditional Chinese medicine compared with conventional western medicine in the treatment of chronic uric acid nephropathy.The search deadline was set to June 30,2020.For the included literature,we applied the cochrane collaboration network risk bias assessment tool to evaluate the methodological quality,and evaluated the level of evidence according to GRADE standards.Quantitative data was analyzed by RevMan5.3 software,and trial sequential analysis method was used to analyze its efficiency.Results:A total of 709 cases in 10 articles were included.Compared with the control group,the related traditional Chinese medicine group improved the effective rate[RR=1.45,95%CI(1.32,1.58)],reduced the level of UA[MD=-36.24,95%CI(-41.03,-31.45)],BUN[SMD=-1.27,95%CI(-1.47,-1.07)]and SCR[MD=-36.33,95%CI(-55.79,-16.87),P=0.0003],the difference between the two groups was statistically significant(P<0.05).There was no evidence that a significant adverse reaction occurred.The results of TSA analysis showed that the Chinese medicine group had definite evidence for improving the efficiency.According to the GRADE evaluation criteria,the efficiency,UA,BUN and SCR outcome indicators were extremely low-quality evidence.Conclusions:Traditional Chinese medicine for regulating spleen and kidney in the treatment of chronic uric acid nephropathy improved efficiency,reduced the level of UA,BUN,SCR.Meanwhile,the therapy was proved to be safe.Nevertheless,the conclusions need further high-quality evidence to support.

The Influence of Kidney Stones and Salivary Uric Acid on Dental Calculus Formation and Periodontal Status among Some Saudi Patients Aged 25 - 70 Years

Background: The formation of kidney stones is considered a complicated process. Consequently, there are many questions about the link between kidney stones formation and level of salivary uric acid and calculus formation on the teeth surfaces. Objectives: To evaluate the correlation between the level of salivary uric acid and kidney stones formation and their influence on dental calculus and periodontal status among Saudi patients aged 25 - 70 years. Materials and Methods: 120 Saudi male patients were examined (60 of Kidney stones patients and 60 patients of non-kidney stones patients) for clinical evaluation of plaque index (PLI), gingival index (GI), calculus index of oral hygiene (CI) and clinical attachment loss (CAL). Moreover, lab assessment of uric acid level in the collected salivary samples was done. The findings were analyzed using of ANOVA test and Tukey’s test. Results: There were statistically significant differences in clinical parameters among kidney stones patients and non-kidney stones patients (p < 0.05), but these differences were highly statistically significant in the correlation between calculus index (CI), plaque index (PLI) and gingival index (GI) among kidney stone patients in group II, moreover, PLI and clinical attachment loss (CAL) among kidney stone patients in group III (p < 0.001). The statistical analyses revealed statistically significant differences in the level of salivary uric acid (mg/dl) in the comparison between kidney stones patients and non-kidney stones patients in group I and group III, whereas there were highly statistically significant in the comparison between kidney stones patients and non-kidney stones patients in group III. Conclusion: At the end of this study, we concluded that there was a relationship between dental calculus formation, kidney stones formation, and an increase in the level of salivary uric acid.

Role of insulin resistance in uric acid nephrolithiasis

Metabolic syndrome has been implicated in the pathogenesis of uric acid stones.Although not completely understood,its role is supported by many studies demonstrating increased prevalence of uric acid stones in patients with metabolic syndrome and in particular insulin resistance,a major component of metabolic syndrome.This review presents epidemiologic studies demonstrating the association between metabolic syndrome and nephrolithiasis in general as well as the relationship between insulin resistance and uric acid stone formation,in particular.We also review studies that explore the pathophysiologic relationship between insulin resistance and uric acid nephrolithiasis.

Andrias davidianus bone peptides alleviates hyperuricemia-induced kidney damage in vitro and in vivo

Hyperuricemia(HUA)is a vital risk factor for chronic kidney diseases(CKD)and development of functional foods capable of protecting CKD is of importance.This paper aimed to explore the amelioration effects and mechanism of Andrias davidianus bone peptides(ADBP)on HUA-induced kidney damage.In the present study,we generated the standard ADBP which contained high hydrophobic amino acid and low molecular peptide contents.In vitro results found that ADBP protected uric acid(UA)-induced HK-2 cells from damage by modulating urate transporters and antioxidant defense.In vivo results indicated that ADBP effectively ameliorated renal injury in HUA-induced CKD mice,evidenced by a remarkable decrease in serum UA,creatinine and blood urea nitrogen,improving kidney UA excretion,antioxidant defense and histological kidney deterioration.Metabolomic analysis highlighted 14 metabolites that could be selected as potential biomarkers and attributed to the amelioration effects of ADBP on CKD mice kidney dysfunction.Intriguingly,ADBP restored the gut microbiome homeostasis in CKD mice,especially with respect to the elevated helpful microbial abundance,and the decreased harmful bacterial abundance.This study demonstrated that ADBP displayed great nephroprotective effects,and has great promise as a food or functional food ingredient for the prevention and treatment of HUA-induced CKD.

Predictive Value of Serum Creatinine, Blood Urea Nitrogen,Uric Acid, and β2-Microglobulin in the Evaluation of Acute Kidney Injury after Orthotopic Liver Transplantation

Background：As a major complication after orthotopic liver transplantation （OLT）,the occurrence of acute kidney injury （AKI） is frequently defined by serum creatinine （Cr）;however,the accuracy of commonly used blood urea nitrogen （BUN）,uric acid （UA）,and β2-microglobulin （β2-MG） remains to be explored.This retrospective study compared the accuracy of these parameters for post-OLT AKI evaluation.Methods：Patients who underwent OLT in three centers between July 2003 and December 2013 were enrolled.The postoperative AKI group was diagnosed by the Kidney Disease Improving Global Outcomes （KDIGO） criteria and classified by stage.Measurement data were analyzed using the t-test or Wilcoxon rank-sum test;enumerated data were analyzed using the Chi-square test or Fisher＇s exact test.Diagnostic reliability and predictive accuracy were evaluated using receiver operating characteristic （ROC） curve analysis.Results：This study excluded 976 cases and analyzed 697 patients （578 men and 1 1 9 women）;the post-OLT AKI incidence was 0.409.Compared with the no-AKI group,the AKI group showed very significant differences in Model for End-stage Liver Disease score （14.74 ± 9.91 vs.11.07 ± 9.54,Z =5.404;P ＜ 0.001）,hepatic encephalopathy （45 [15.8％] vs.30 [7.3％],x2 =12.699;P ＜ 0.001）,hemofiltration （28 [9.8％] vs.0 [0.0％],x2 =42.171;P ＜ 0.001）,and 28-day mortality （23 [8.1％] vs.9 [2.2％],x2 13.323;P ＜0.001）.Moreover,mean values of Cr,BUN,UA,and β2-MG in the AKI group differed significantly at postoperative days 1,3,and 7 （all P ＜0.001）.ROC curve area was 0.847 of Cr for the detection of AKI Stage 1 （sensitivity 80.1％,specificity 75.7％,cutoffvalue 88.23 μmol/L）,0.916 for Stage 2 （sensitivity 87.6％,specificity 82.6％,cutoff value 99.9 μmol/L）,and 0.972 for Stage 3 （sensitivity 94.1％,specificity 88.2％,cutoff value 122.90 μmol/L）.Conclusion：The sensitivity and specificity of serum Cr might be a high-value indicator for the diagnosis and grading of post-OLT AKI.

An Observational Study on the Clinical and Nutritional Factors Determining the Kidney Function at One Year after Transplantation

Objective: The aim of the present study was to investigate the clinical and nutritional factors influencing the renal function of the transplanted kidney during a one-year follow-up period after transplantation. Patients: The present prospective observational study included 52 patients who underwent kidney transplantation at Jichi Medical University Hospital from 2014 to 2016. Results: The serum creatinine (sCr) concentration at one month after transplantation was closely related to the concentration at 12 months. The recipients were divided into two groups based on the sCr concentration at one month after transplantation. Recipients with a sCr concentration greater than or equal to the median were classified into Group H, while those with concentrations that were less than the median were classified into Group L. A stepwise multiple regression analysis demonstrated that the salt intake in male recipients was an independent predictor of the renal function at 12 months (β = 0.663, p β = 0.618, p < 0.01). Moreover, in female recipients, the BMI and serum uric acid values in Group H were significantly higher than those in Group L. The BMI values of the female recipients in Group H were significantly higher than those in Group L at all times during the follow-up period (p < 0.01). Conclusion: The daily salt intake was independently associated with the renal function at one year after kidney transplantation in male recipients. In female recipients, the BMI was independently associated with the sCr concentration during the one-year follow-up period.

Occupational Exposure to Paints Causes Impairment of Kidney Functions

It has been suggested that exposure to organic solvents may have a role in the impairment of kidney function that may progress to kidney failure. However, this has never been evaluated with an appropriate analytical study of the kidney functions of those people who are chronically exposed to these chemicals. This study was designed to measure the kidney function of car painters in the city of Makkah, Saudi Arabia. Fifty workers were selected at random for this study and compared to thirty male medical students who were taken as a control group. Blood samples were collected for the analysis of kidney function. The levels of blood urea nitrogen (BUN), creatinine, and uric acid were scientifically higher in the tested group compared to the control group. In addition to this, the levels of these parameters were significantly higher in the serum of car painters who worked in this industry for more than ten years compared to painters who worked for less than ten years. Moreover, the number of car painters who were not using protective gloves and masks during working hours were 43 and the number of car painters who visited specialized clinics because of kidney problems were 45 of the 50 tested volunteers. These findings support the hypothesized association of solvent exposure with the development of chronic renal failure. They should prompt clinicians to give greater attention to patients’ occupational exposures. Routine monitoring of kidney functions and the use of protective materials are of greater importance to minimize the occupational diseases caused by organic solvents.

低尿酸血症临床病因分析

目的探讨低尿酸血症的病因。方法对该院240例血清尿酸浓度低于115μmol/L住院患者进行回顾分析。结果240例低尿酸血症患者中,恶性肿瘤130例,占55%,其他疾病共110例。造成低尿酸血症的主要原因是尿酸合成障碍和排出量增加两方面。结论低尿酸血症是许多疾病的预示指标,应引起临床医务工作者的重视,并防止其合并症。

The influence of metabolic syndrome and its components on the development of nephrolithiasis

The prevalence of kidney stone disease is increasing,afflicting 7%-11% of the United States population.Multiple systemic conditions,including obesity and diabetes,are also on the rise.Further,the literature has demonstrated a strong association between metabolic syndrome,its components,and kidney stone disease.In this article,we aim to review the associations of metabolic syndrome and nephrolithiasis,discussing the pathophysiology,urinary parameters,and clinical presentations.With this knowledge,urologists will have a more comprehensive understanding of this complex population of metabolic stone formers enabling improved patient management and treatment of stone disease.

The genetic framework for development of nephrolithiasis

Over 1%-15% of the population worldwide is affected by nephrolithiasis,which remains the most common and costly disease that urologists manage today.Identification of atrisk individuals remains a theoretical and technological challenge.The search for monogenic causes of stone disease has been largely unfruitful and a technological challenge;however,several candidate genes have been implicated in the development of nephrolithiasis.In this review,we will review current data on the genetic inheritance of stone disease,as well as investigate the evolving role of genetic analysis and counseling in the management of nephrolithiasis.

老年高血压患者颈动脉硬化与血尿酸水平关系的探讨

目的:比较老年高血压患者血尿酸水平与血压及颈动脉硬化程度的相关性。方法:将102例老年高血压患者按血压值的不同分为三组,比较各组间血尿酸与血压的相关性,对各例患者分别检测血生化指标:空腹血糖(FBG)、血尿酸(UA)、甘油三脂(TG)和总胆固醇(TC),B超观察颈动脉变化,按B超结果将患者分为内膜正常组、内膜增厚组、斑块形成组和管腔狭窄组,比较各组间血压、血尿酸水平。结果:三组高血压患者血尿酸值分别为(318±35)、(366±37)、(426±52)μmol/L,各组间比较差异有显著性(P<0.01)。颈动脉内膜正常组血尿酸值为(269±51)μmol/L,内膜异常组血尿酸值依次为(318±38)、(366±46)、(429±51)μmol/L,各组间比较血尿酸值的差异有显著性(P<0.01)。结论:老年高血压患者颈动脉硬化程度与血压、血尿酸水平呈正相关。提示高尿酸血症是高血压病的危险因素之一,高尿酸血症与高血压是心血管疾病的重要易感因素。

Hypertension in children with obesity

The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity.This pediatric health problem may adversely affect cardiovascular health in adult life.The pathogenesis of hypertension in obese children is not widely understood.We therefore undertake this review to raise public awareness.Early childhood parameters like birth weight and postnatal weight gain may play important roles in risk for obesity and obesity related hypertension later in childhood and adult life.Further information is required to confirm this origin of hypertension so that appropriate measures are taken in the peri-natal period.The role of sympathetic nervous system has now been well established as one of the principle mechanisms involved in obesity related hypertension.The Renin-Angiotensin system,insulin resistance due to obesity and as a part of metabolic syndrome along with imbalance in adipokines such as leptin and adiponectin,cause activation of the sympathetic system,vasoconstriction,endothelial dysfunction and sodium reabsorption among other perturbations.Multi-step interventions targeting these various mech-anisms are required to break the cycle of obesity and metabolic syndrome.Vitamin D deficiency,sleep apnea due to airway obstruction and hyperuricemia may also play a significant role and should not be ignored in its early stages.Obesity is a risk factor for other comorbid conditions like chronic kidney disease and fatty liver which further accentuate the risk of hypertension.Increased awareness is required to prevent,diagnose and treat obesity related hypertension among the pediatric population.

AVP在老年性高血压发病中的作用及其与血尿酸的关系

测定了３５例低肾素性老年高血压病患者降压治疗前后血浆精氨酸加压素（ＡＶＰ）和血清尿酸浓度的改变，并与３０例正常人作对照。结果表明：①患者ＡＶＰ浓度显著增高（Ｐ＜０．０１），且与血压呈正相关。②患者血清尿酸浓度高于正常（Ｐ＜０．０１），且与血浆ＡＶＰ水平呈正相关，与血压无明显相关；降压治疗均恢复正常。ＡＶＰ的下降与尿酸下降呈正相关。提示ＡＶＰ参与低肾素性老年高血压病的发病过程。

Changes in biochemical parameters on the first day after kidney transplantation： risk factors for nosocomial infection？

Background Nosocomial infection in early post-transplantation period is a tough problem for kidney transplantation. Few reports have explored the relations between biochemical parameters and nosocomial infection in kidney transplantation. This retrospective study was carried out to describe the characteristics of nosocomial infection in the very early period of kidney transplantation and to determine the risk factors in biochemical parameters and their alterations. Methods Patients who underwent their first kidney transplantation from January 2001 to March 2009 in Beijing Chao-Yang Hospital were recruited and the nosocomial infectious episodes were collected for this study. Gender, age, donor type, delayed graft function （DGF） and biochemical parameters such as serum uric acid, lipids files and albumin on day 0 （before transplantation） and day 1 （24 hours after transplantation） and their changes were analyzed with Logistic regression models for nosocomial infection. Results A total of 405 patients （315 men and 90 women） were involved in this study. There were 80 patients experiencing 113 infection episodes and 105 strains of microorganism were indentified. In univariate analysis, there were significant differences in DGF, albumin on day 0, lipoprotein （a） （Lp（a）） on day 1, change in low density lipoprotein-cholesterol （LDL-C, day 1-day 0） and change in uric acid （day 1-day 0） between nosocomial infection patients and noninfectious patients （P 〈0.05）. In multivariate analysis, change in uric acid （day 1-day 0） （OR 5.139, 95% CI 1.176-22.465, P 〈0.05）, change in LDL-C （day 1-day 0） （OR4.179, 95% CI 1.375-12.703, P 〈0.05） and DGF （OR 14.409, 95% CI 1.603-129.522, P 〈0.05） were identified as independent risk factors for nosocomial infection in kidney transplantation. Conclusions Most nosocomial infections in early postoperative period of kidney transplantation are bacterial, especially with Gram-negative bacteria. The most common infection sites are respiratory tract, urinary tract and surgical site. DGF, decrease of LDL-C and increase of uric acid could increase the risk for nosocomial infections.

尿酸与阿尔茨海默病患者不同认知功能域的相关研究

目的研究分析尿酸对阿尔茨海默病（ao）患者不同认知功能域的影响。方法选取46例阿尔茨海默病患者和50例正常对照者，分别测定血尿酸和进行MOCA评分、ADL评分。结果AD患者血尿酸水平为（217．93±67．91）μmol／L，正常对照组血尿酸水平为（337．02±59．70）μmol／L。AD患者血尿酸水平较正常对照组低，差异有统计学意义（t=9．142，P〈0．01）。多元回归分析显示AD患者的认知功能可能与血尿酸、年龄、受教育年限、高血压有关（P〈0．01，P〈0．05）。Partial相关分析发现尿酸水平与AD认知域中记忆力（r=0．457，P=0．002）和注意力（r=0．398，P=0．008）呈显著正相关。结论低水平血尿酸可能对AD的发生发展起一定作用，且血尿酸对AD患者记忆力和注意力的影响可能相对较大些。