Skip to main content
Erschienen in: Clinical Rheumatology 1/2016

01.01.2016 | Original Article

Influence of urate-lowering therapies on renal handling of uric acid

verfasst von: Lili Ma, Lei Wei, Huiyong Chen, Zhuojun Zhang, Qiang Yu, Zongfei Ji, Lindi Jiang

Erschienen in: Clinical Rheumatology | Ausgabe 1/2016

Einloggen, um Zugang zu erhalten

Abstract

The purpose of this study is to investigate the effect of urate-lowering therapies (ULTs) on renal uric acid excretion in gout patients. This prospective observational study involved 106 primary gout patients and 51 healthy controls. Gout patients received ULT with either xanthine oxidase inhibitors or the uricosuric agent benzbromarone. Parameters such as 24-h urinary uric acid, creatinine clearance, uric acid clearance, glomerular filtration load of uric acid, fractional excretion of uric acid, excretion of uric acid per volume of glomerular filtration, and urinary uric acid to urinary creatinine ratio were used to evaluate the pre- and post-treatment renal capacity for uric acid clearance in gout patients and were compared with the values in the healthy controls. Compared to healthy controls, gout patients had higher glomerular filtration load of uric acid and lower uric acid clearance, creatinine clearance, and fractional uric acid excretion. After ULT, both the xanthine oxidase inhibitor group and benzbromarone group patients showed reduction in glomerular filtration load of uric acid. Creatinine clearance was significantly improved in the xanthine oxidase inhibitor group. Excretion function was remarkably enhanced in patients who reached the treatment target (serum uric acid <6 mg/dl). Changes in glomerular uric acid filtration load were significantly correlated with changes in serum urate levels. Gout patients have impaired renal uric acid excretion. ULTs reduce renal urate load and enhance the renal capacity of uric acid clearance. Xanthine oxidase inhibitors showed superiority over benzbromarone in improving renal function.
Literatur
1.
Zurück zum Zitat Ichida K, Matsuo H, Takada T, Nakayama A, Murakami K, Shimizu T, Yamanashi Y, Kasuga H, Nakashima H, Nakamura T, Takada Y, Kawamura Y, Inoue H, Okada C, Utsumi Y, Ikebuchi Y, Ito K, Nakamura M, Shinohara Y, Hosoyamada M, Sakurai Y, Shinomiya N, Hosoya T, Suzuki H (2012) Decreased extra-renal urate excretion is a common cause of hyperuricemia. Nat Commun 3:764. doi:10.1038/ncomms1756 PubMedPubMedCentralCrossRef Ichida K, Matsuo H, Takada T, Nakayama A, Murakami K, Shimizu T, Yamanashi Y, Kasuga H, Nakashima H, Nakamura T, Takada Y, Kawamura Y, Inoue H, Okada C, Utsumi Y, Ikebuchi Y, Ito K, Nakamura M, Shinohara Y, Hosoyamada M, Sakurai Y, Shinomiya N, Hosoya T, Suzuki H (2012) Decreased extra-renal urate excretion is a common cause of hyperuricemia. Nat Commun 3:764. doi:10.​1038/​ncomms1756 PubMedPubMedCentralCrossRef
2.
Zurück zum Zitat Khachadurian AK (1981) Hyperuricemia and gout: an update. Am Fam Physician 24(6):143–148PubMed Khachadurian AK (1981) Hyperuricemia and gout: an update. Am Fam Physician 24(6):143–148PubMed
4.
Zurück zum Zitat GUTMAN AB, Yu TF (1957) Renal function in gout; with a commentary on the renal regulation of urate excretion, and the role of the kidney in the pathogenesis of gout. Am J Med 23(4):600–622PubMedCrossRef GUTMAN AB, Yu TF (1957) Renal function in gout; with a commentary on the renal regulation of urate excretion, and the role of the kidney in the pathogenesis of gout. Am J Med 23(4):600–622PubMedCrossRef
7.
Zurück zum Zitat Mount DB (2005) Molecular physiology and the four-component model of renal urate transport. Curr Opin Nephrol Hypertens 14(5):460–463PubMedCrossRef Mount DB (2005) Molecular physiology and the four-component model of renal urate transport. Curr Opin Nephrol Hypertens 14(5):460–463PubMedCrossRef
9.
Zurück zum Zitat Terkeltaub R, Bushinsky DA, Becker MA (2006) Recent developments in our understanding of the renal basis of hyperuricemia and the development of novel antihyperuricemic therapeutics. Arthritis Res Ther 8 Suppl 1:S4.doi:10.1186/ar1909 Terkeltaub R, Bushinsky DA, Becker MA (2006) Recent developments in our understanding of the renal basis of hyperuricemia and the development of novel antihyperuricemic therapeutics. Arthritis Res Ther 8 Suppl 1:S4.doi:10.​1186/​ar1909
11.
12.
Zurück zum Zitat Chung W, Kim AJ, Ro H, Chang JH, Lee HH, Jung JY (2013) Hyperuricemia is an independent risk factor for mortality only if chronic kidney disease is present. Am J Nephrol 37(5):452–461. doi:10.1159/000350534 PubMedCrossRef Chung W, Kim AJ, Ro H, Chang JH, Lee HH, Jung JY (2013) Hyperuricemia is an independent risk factor for mortality only if chronic kidney disease is present. Am J Nephrol 37(5):452–461. doi:10.​1159/​000350534 PubMedCrossRef
13.
Zurück zum Zitat Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, Chen M, He Q, Liao Y, Yu X, Chen N, Zhang JE, Hu Z, Liu F, Hong D, Ma L, Liu H, Zhou X, Chen J, Pan L, Chen W, Wang W, Li X, Wang H (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822. doi:10.1016/S0140-6736(12)60033-6 PubMedCrossRef Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, Chen M, He Q, Liao Y, Yu X, Chen N, Zhang JE, Hu Z, Liu F, Hong D, Ma L, Liu H, Zhou X, Chen J, Pan L, Chen W, Wang W, Li X, Wang H (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822. doi:10.​1016/​S0140-6736(12)60033-6 PubMedCrossRef
14.
Zurück zum Zitat Koka RM, Huang E, Lieske JC (2000) Adhesion of uric acid crystals to the surface of renal epithelial cells. Am J Physiol Ren Physiol 278(6):F989–F998 Koka RM, Huang E, Lieske JC (2000) Adhesion of uric acid crystals to the surface of renal epithelial cells. Am J Physiol Ren Physiol 278(6):F989–F998
16.
17.
Zurück zum Zitat Wang CY, Cogswell ME, Loria CM, Chen TC, Pfeiffer CM, Swanson CA, Caldwell KL, Perrine CG, Carriquiry AL, Liu K, Sempos CT, Gillespie CD, Burt VL (2013) Urinary excretion of sodium, potassium, and chloride, but not iodine, varies by timing of collection in a 24-hour calibration study. J Nutr 143(8):1276–1282. doi:10.3945/jn.113.175927 PubMedCrossRef Wang CY, Cogswell ME, Loria CM, Chen TC, Pfeiffer CM, Swanson CA, Caldwell KL, Perrine CG, Carriquiry AL, Liu K, Sempos CT, Gillespie CD, Burt VL (2013) Urinary excretion of sodium, potassium, and chloride, but not iodine, varies by timing of collection in a 24-hour calibration study. J Nutr 143(8):1276–1282. doi:10.​3945/​jn.​113.​175927 PubMedCrossRef
18.
Zurück zum Zitat Kayatas S, Erdogdu E, Cakar E, Yılmazer V, Arınkan SA, Dayıcıoglu VE (2013) Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia. Eur J Obstet Gynecol Reprod Biol 170(2):368–371. doi:10.1016/j.ejogrb PubMedCrossRef Kayatas S, Erdogdu E, Cakar E, Yılmazer V, Arınkan SA, Dayıcıoglu VE (2013) Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia. Eur J Obstet Gynecol Reprod Biol 170(2):368–371. doi:10.​1016/​j.​ejogrb PubMedCrossRef
19.
Zurück zum Zitat Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612PubMedPubMedCentralCrossRef Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612PubMedPubMedCentralCrossRef
20.
Zurück zum Zitat Perez-Ruiz F, Calabozo M, Erauskin GG, Ruibal A, Herrero-Beites AM (2002) Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output. Arthritis Rheum 47(6):610–613. doi:10.1002/art.10792 PubMedCrossRef Perez-Ruiz F, Calabozo M, Erauskin GG, Ruibal A, Herrero-Beites AM (2002) Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output. Arthritis Rheum 47(6):610–613. doi:10.​1002/​art.​10792 PubMedCrossRef
21.
Zurück zum Zitat Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, Pillinger MH, Merill J, Lee S, Prakash S, Kaldas M, Gogia M, Perez-Ruiz F, Taylor W, Lioté F, Choi H, Singh JA, Dalbeth N, Kaplan S, Niyyar V, Jones D, Yarows SA, Roessler B, Kerr G, King C, Levy G, Furst DE, Edwards NL, Mandell B, Schumacher HR, Robbins M, Wenger N, Terkeltaub R, American College of Rheumatology (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res 64(10):1447–1461. doi:10.1002/acr.21773 CrossRef Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, Pillinger MH, Merill J, Lee S, Prakash S, Kaldas M, Gogia M, Perez-Ruiz F, Taylor W, Lioté F, Choi H, Singh JA, Dalbeth N, Kaplan S, Niyyar V, Jones D, Yarows SA, Roessler B, Kerr G, King C, Levy G, Furst DE, Edwards NL, Mandell B, Schumacher HR, Robbins M, Wenger N, Terkeltaub R, American College of Rheumatology (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res 64(10):1447–1461. doi:10.​1002/​acr.​21773 CrossRef
23.
Zurück zum Zitat Perez-Ruiz F, Alonso-Ruiz A, Calabozo M, Herrero-Beites A, García-Erauskin G, Ruiz-Lucea E (1998) Efficacy of allopurinol and benzbromarone for the control of hyperuricaemia. A pathogenic approach to the treatment of primary chronic gout. Ann Rheum Dis 57(9):545–549. doi:10.1136/ard.57.9.545 PubMedPubMedCentralCrossRef Perez-Ruiz F, Alonso-Ruiz A, Calabozo M, Herrero-Beites A, García-Erauskin G, Ruiz-Lucea E (1998) Efficacy of allopurinol and benzbromarone for the control of hyperuricaemia. A pathogenic approach to the treatment of primary chronic gout. Ann Rheum Dis 57(9):545–549. doi:10.​1136/​ard.​57.​9.​545 PubMedPubMedCentralCrossRef
25.
Zurück zum Zitat Lin KC, Lin HY, Chou P (2000) The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol 27(6):1501–1505PubMed Lin KC, Lin HY, Chou P (2000) The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol 27(6):1501–1505PubMed
26.
Zurück zum Zitat Mazzali M, Kanellis J, Han L, Feng L, Xia YY, Chen Q, Kang DH, Gordon KL, Watanabe S, Nakagawa T, Lan HY, Johnson RJ (2002) Hyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure-independent mechanism. Am J Physiol Ren Physiol 282(6):991–997CrossRef Mazzali M, Kanellis J, Han L, Feng L, Xia YY, Chen Q, Kang DH, Gordon KL, Watanabe S, Nakagawa T, Lan HY, Johnson RJ (2002) Hyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure-independent mechanism. Am J Physiol Ren Physiol 282(6):991–997CrossRef
27.
Zurück zum Zitat Perlstein TS, Gumieniak O, Hopkins PN, Murphey LJ, Brown NJ, Williams GH, Hollenberg NK, Fisher ND (2004) Uric acid and the state of the intrarenal renin-angiotensin system in humans. Kidney Int 66(4):1465–1470PubMedCrossRef Perlstein TS, Gumieniak O, Hopkins PN, Murphey LJ, Brown NJ, Williams GH, Hollenberg NK, Fisher ND (2004) Uric acid and the state of the intrarenal renin-angiotensin system in humans. Kidney Int 66(4):1465–1470PubMedCrossRef
28.
Zurück zum Zitat Berni A, Boddi M, Fattori EB, Cecioni I, Berardino S, Montuschi F, Chiostri M, Poggesi L (2010) Serum uric acid levels and renal damage in hyperuricemic hypertensive patients treated with renin-angiotensin system blockers. Am J Hypertens 23(6):675–680PubMedCrossRef Berni A, Boddi M, Fattori EB, Cecioni I, Berardino S, Montuschi F, Chiostri M, Poggesi L (2010) Serum uric acid levels and renal damage in hyperuricemic hypertensive patients treated with renin-angiotensin system blockers. Am J Hypertens 23(6):675–680PubMedCrossRef
29.
Zurück zum Zitat Enomoto A, Kimura H, Chairoungdua A, Shigeta Y, Jutabha P, Cha SH, Hosoyamada M, Takeda M, Sekine T, Igarashi T, Matsuo H, Kikuchi Y, Oda T, Ichida K, Hosoya T, Shimokata K, Niwa T, Kanai Y, Endou H (2002) Molecular identification of a renal urate-anion exchanger that regulates blood urate levels. Nature 417(6887):447–452PubMed Enomoto A, Kimura H, Chairoungdua A, Shigeta Y, Jutabha P, Cha SH, Hosoyamada M, Takeda M, Sekine T, Igarashi T, Matsuo H, Kikuchi Y, Oda T, Ichida K, Hosoya T, Shimokata K, Niwa T, Kanai Y, Endou H (2002) Molecular identification of a renal urate-anion exchanger that regulates blood urate levels. Nature 417(6887):447–452PubMed
30.
Zurück zum Zitat Iwanaga T, Sato M, Maeda T, Ogihara T, Tamai I (2007) Concentration-dependent mode of interaction of angiotensin II receptor blockers with uric acid transporter. J Pharmacol Exp Ther 320(1):211–217PubMedCrossRef Iwanaga T, Sato M, Maeda T, Ogihara T, Tamai I (2007) Concentration-dependent mode of interaction of angiotensin II receptor blockers with uric acid transporter. J Pharmacol Exp Ther 320(1):211–217PubMedCrossRef
31.
Zurück zum Zitat Kang DH, Nakagawa T, Feng L, Watanabe S, Han L, Mazzali M, Truong L, Harris R, Johnson RJ (2002) A role for uric acid in the progression of renal disease. J Am Soc Nephrol 13(12):2888–2897PubMedCrossRef Kang DH, Nakagawa T, Feng L, Watanabe S, Han L, Mazzali M, Truong L, Harris R, Johnson RJ (2002) A role for uric acid in the progression of renal disease. J Am Soc Nephrol 13(12):2888–2897PubMedCrossRef
34.
Zurück zum Zitat Emmerson BT, Nagel SL, Duffy DL, Martin NG (1992) Genetic control of the renal clearance of urate: a study of twins. Ann Rheum Dis 51(3):375–377PubMedPubMedCentralCrossRef Emmerson BT, Nagel SL, Duffy DL, Martin NG (1992) Genetic control of the renal clearance of urate: a study of twins. Ann Rheum Dis 51(3):375–377PubMedPubMedCentralCrossRef
35.
Zurück zum Zitat Storhaug HM, Norvik JV, Toft I, Eriksen BO, Løchen ML, Zykova S, Solbu M, White S, Chadban S, Jenssen T (2013) Uric acid is a risk factor for ischemic stroke and all-cause mortality in the general population: a gender specific analysis from The Tromsø Study. BMC Cardiovasc Disord 13:115. doi:10.1186/1471-2261-13-115 PubMedPubMedCentralCrossRef Storhaug HM, Norvik JV, Toft I, Eriksen BO, Løchen ML, Zykova S, Solbu M, White S, Chadban S, Jenssen T (2013) Uric acid is a risk factor for ischemic stroke and all-cause mortality in the general population: a gender specific analysis from The Tromsø Study. BMC Cardiovasc Disord 13:115. doi:10.​1186/​1471-2261-13-115 PubMedPubMedCentralCrossRef
36.
Zurück zum Zitat Nagahama K, Inoue T, Kohagura K, Ishihara A, Kinjo K, Ohya Y (2013) Hyperuricemia predicts future metabolic syndrome: a 4-year follow-up study of a large screened cohort in Okinawa, Japan. Hypertens Res 37(3):232–238PubMedCrossRef Nagahama K, Inoue T, Kohagura K, Ishihara A, Kinjo K, Ohya Y (2013) Hyperuricemia predicts future metabolic syndrome: a 4-year follow-up study of a large screened cohort in Okinawa, Japan. Hypertens Res 37(3):232–238PubMedCrossRef
37.
Zurück zum Zitat Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, Davos CH, Cicoira M, Shamim W, Kemp M, Segal R, Osterziel KJ, Leyva F, Hetzer R, Ponikowski P, Coats AJ (2003) Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation 107(15):1991–1997PubMedCrossRef Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, Davos CH, Cicoira M, Shamim W, Kemp M, Segal R, Osterziel KJ, Leyva F, Hetzer R, Ponikowski P, Coats AJ (2003) Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation 107(15):1991–1997PubMedCrossRef
38.
Zurück zum Zitat Ramasamy SN, Korb-Wells CS, Kannangara DR, Smith MW, Wang N, Roberts DM, Graham GG, Williams KM, Day RO (2013) Allopurinol hypersensitivity: a systematic review of all published cases, 1950–2012. Drug Saf 36(10):953–980PubMedCrossRef Ramasamy SN, Korb-Wells CS, Kannangara DR, Smith MW, Wang N, Roberts DM, Graham GG, Williams KM, Day RO (2013) Allopurinol hypersensitivity: a systematic review of all published cases, 1950–2012. Drug Saf 36(10):953–980PubMedCrossRef
Metadaten
Titel
Influence of urate-lowering therapies on renal handling of uric acid
verfasst von
Lili Ma
Lei Wei
Huiyong Chen
Zhuojun Zhang
Qiang Yu
Zongfei Ji
Lindi Jiang
Publikationsdatum
01.01.2016
Verlag
Springer London
Erschienen in
Clinical Rheumatology / Ausgabe 1/2016
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-014-2806-9

Weitere Artikel der Ausgabe 1/2016

Clinical Rheumatology 1/2016 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Schadet Ärger den Gefäßen?

14.05.2024 Arteriosklerose Nachrichten

In einer Studie aus New York wirkte sich Ärger kurzfristig deutlich negativ auf die Endothelfunktion gesunder Probanden aus. Möglicherweise hat dies Einfluss auf die kardiovaskuläre Gesundheit.

Intervallfasten zur Regeneration des Herzmuskels?

14.05.2024 Herzinfarkt Nachrichten

Die Nahrungsaufnahme auf wenige Stunden am Tag zu beschränken, hat möglicherweise einen günstigen Einfluss auf die Prognose nach akutem ST-Hebungsinfarkt. Darauf deutet eine Studie an der Uniklinik in Halle an der Saale hin.

Klimaschutz beginnt bei der Wahl des Inhalators

14.05.2024 Klimawandel Podcast

Auch kleine Entscheidungen im Alltag einer Praxis können einen großen Beitrag zum Klimaschutz leisten. Die neue Leitlinie zur "klimabewussten Verordnung von Inhalativa" geht mit gutem Beispiel voran, denn der Wechsel vom klimaschädlichen Dosieraerosol zum Pulverinhalator spart viele Tonnen CO2. Leitlinienautor PD Dr. Guido Schmiemann erklärt, warum nicht nur die Umwelt, sondern auch Patientinnen und Patienten davon profitieren.

Zeitschrift für Allgemeinmedizin, DEGAM

Typ-2-Diabetes und Depression folgen oft aufeinander

14.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes sind überdurchschnittlich gefährdet, in den nächsten Jahren auch noch eine Depression zu entwickeln – und umgekehrt. Besonders ausgeprägt ist die Wechselbeziehung laut GKV-Daten bei jüngeren Erwachsenen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.