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Augmented Association Between Blood Pressure and Proteinuria in Hyperuricemic Patients With Nonnephrotic Chronic

Kentaro Kohagura1,2, Masako Kochi2, Tsuyoshi Miyagi2

  • 1Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan.

American Journal of Hypertension
|September 21, 2017
PubMed

Insights

High uric acid levels in patients with chronic kidney disease worsen blood pressure effects on protein in urine, increasing hypertensive kidney damage risk. This association is linked to arteriolar hyalinosis.

Area of Science:

  • Nephrology
  • Hypertension Research
  • Uric Acid Metabolism

Background:

  • Hyperuricemia (HU) may increase susceptibility to hypertensive renal damage by disrupting glomerular hemodynamics.
  • The impact of HU on the relationship between blood pressure (BP) and proteinuria in chronic kidney disease (CKD) patients is not well understood.

Purpose of the Study:

  • To investigate the association between blood pressure and urine protein levels in patients with non-nephrotic CKD, considering the presence of hyperuricemia.
  • To determine if hyperuricemia modifies the effect of blood pressure on proteinuria in CKD.

Main Methods:

  • 109 patients with non-nephrotic CKD were analyzed, assessing arteriolar hyalinosis.
  • Correlation between BP and urine protein (UP) was examined based on HU status (serum uric acid levels or urate-lowering drug use).
  • Statistical analyses included correlation and multiple regression, with adjustments for confounding factors.

Main Results:

  • In patients with HU (n=59), systolic BP was significantly correlated with UP levels (r=0.49, P<0.0001), but not in those without HU (n=50).
  • Multiple regression showed a significant interaction between HU and SBP concerning proteinuria (β=7.0, P=0.03).
  • This statistical significance was eliminated after adjusting for the arteriolar hyalinosis index.

Conclusions:

  • Hyperuricemia potentiates susceptibility to hypertensive glomerular damage in non-nephrotic CKD patients.
  • Disrupted autoregulation of glomerular hemodynamics is implicated in this process.
  • Arteriolar hyalinosis appears to mediate the relationship between HU, BP, and proteinuria.
Abstract

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