Uric Acid and the Kidney

8am Wednesday morning Dr. Wiener discussed the role of uric acid lowering agents in the treatment of CKD. Here are some bullet points:

– A relationship between uric acid and kidney disease has been suggested as early as 1897 in a JAMA paper by Dr. Davis.

– Diets rich in red meat, alcohol and fructose can increase uric acid levels.

– The proposed mechanism behind uric acid and CKD is as follows: Uric acid leads to high renin, decrease in nitrous oxide, and as a result vasoconstriction and hypertension.

– Uric acid mechanism of renal injury may be similar to cyclosporin.

– Rodent models support the role of uric acid in renal fibrosis and treatment by lowering levels. However, the physiology in humans is different as rodents have an enzyme that breaks down uric acid into allantoin.

– Human studies suggest an association between uric acid, hypertension, CVD and CKD. These studies are flawed by short follow up, small numbers and inherent bias in observational studies.

– Unfortunately, there are no randomized controlled studies to prove that lowering uric acid can slow down the progression of CKD.

Conclusion – we need better studies before a strategy for lowering uric acid can be suggested as a treatment in CKD.

Post written by Dr. Vinay Nair,  eAJKD Advisory Board member.

Check out more eAJKD coverage of the NKF’s 2013 Spring Clinical Meetings!