Hyperurikemia in chronic kidney disease stage 4 — the issue of suitability of urate-lowering therapy

I.I. Melnyk
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Abstract

For almost 20 years, the issue of hyperuricemia has been studied in nephrology, rheumatology, cardiology, endocrinology, and neurology areas of medicine. In all countries of the world, new aspects of this clinical symptom are being revealed almost simultaneously, some facts are being disproved, and updated practical re­commendations are being implemented. The main medical axiom now is that hyperuricemia is a symptom of chronic kidney disease (CKD) of any stage, but the pathogenetic mechanisms of the effect of a high uric acid level on kidney function are not known for sure. It is necessary to correct its level under certain clinical and laboratory criteria in order to reduce the risk of cardiovascular disease and the risk of increased mortality, to influence the course of diabetes and possibly prevent obesity. There are still a lot of questions and unexplained facts. For example, what is the role of hyperuricemia in CKD, what level of uric acid reduction is safe and appropriate? What is the causal relationship between uric acid levels and CKD progression? Is the treatment of asymptomatic hyperuricemia effective for absolutely all patients? Is a differentiated approach to lowering the level of uric acid necessary depending on the stage of CKD? When should one take into account the physiological positive effect of hyperuricemia on kidney and vascular cells and not prescribe urate-lowering therapy? Our observation of two patients, which took place within the randomized patient-oriented study “Development of technology to preserve kidney function in patients with CKD and hyperuricemia”, does not provide direct answers to all these questions, but allows us to assume that hyperuricemia can be compensatory for kidney function, and it will not always be appropriate to actively reduce its level. The article aims to draw attention to the fact that when hyperuricemia causes hyperfiltration to preserve kidney function, lowering its level may be inappropriate for absolutely all patients. And maybe in certain conditions and indivi­dual clinical situation, the doctor has the option not to prescribe this type of therapy without negative consequences for kidney function.
慢性肾脏疾病4期高尿素血症-降尿酸治疗的适宜性问题
近20年来,高尿酸血症问题已经在肾脏学、风湿病学、心脏病学、内分泌学和神经学等医学领域得到了研究。在世界所有国家,几乎同时发现了这一临床症状的新方面,一些事实正在被反驳,并且正在实施最新的实用建议。目前主要的医学原理是,高尿酸血症是任何阶段慢性肾脏疾病(CKD)的症状,但高尿酸水平对肾功能影响的发病机制尚不确定。有必要在一定的临床和实验室标准下纠正其水平,以减少心血管疾病的风险和死亡率增加的风险,影响糖尿病的病程,并可能预防肥胖。还有很多问题和无法解释的事实。例如,高尿酸血症在CKD中的作用是什么,什么水平的尿酸降低是安全适当的?尿酸水平与CKD进展之间的因果关系是什么?无症状高尿酸血症的治疗是否对所有患者都有效?是否有必要根据CKD的分期采取不同的方法来降低尿酸水平?什么时候应该考虑到高尿酸血症对肾脏和血管细胞的生理积极作用而不开降尿酸治疗?我们对两名患者的观察,发生在随机患者导向的研究“CKD和高尿酸血症患者肾功能保护技术的发展”中,并不能直接回答所有这些问题,但允许我们假设高尿酸血症可以代偿肾功能,主动降低其水平并不总是合适的。这篇文章的目的是引起人们的注意,当高尿酸血症导致高滤过以保持肾功能时,降低其水平可能不适合所有患者。也许在某些情况下和个人临床情况下,医生可以选择不开这种对肾功能没有负面影响的治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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