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Update on Uric Acid and the Kidney.
Giana Kristy Ramos1,2, David S Goldfarb3,4
1Nephrology Division, NYU Langone Health, New York, NY, USA.
Current Rheumatology Reports
|April 14, 2022
Summary
Recent research indicates that while high uric acid can cause kidney stones, lowering it doesn't slow chronic kidney disease (CKD) or protect against Parkinson's. Higher gout medication doses show promise for CKD management.
Area of Science:
- Nephrology
- Urology
- Endocrinology
Background:
- Elevated serum uric acid is linked to chronic kidney disease (CKD) progression.
- Previous studies on slowing CKD progression with uric acid-lowering medications yielded mixed results.
- The role of uric acid in neuroprotection and its association with kidney stones requires further investigation.
Purpose of the Study:
- To review recent findings on uric acid's association with kidney health, including kidney stones, CKD, and gout management.
- To evaluate the impact of manipulating uric acid levels on CKD progression and neuroprotection.
- To assess the safety and efficacy of higher-dose urate-lowering therapies.
Main Methods:
- Review of recent clinical studies and trials (e.g., PERL, CKD-FIX, SURE-PD3, STOP-GOUT).
- Analysis of factors contributing to uric acid stone formation, including urinary pH.
- Examination of the effects of medications like allopurinol, febuxostat, and thiazolidinediones.
Main Results:
- Studies did not confirm that allopurinol slows CKD progression.
- Increasing uric acid did not slow Parkinson's disease progression; however, high urinary uric acid caused uric acid stones, linked to low urinary pH.
- Higher doses of allopurinol and febuxostat showed a lack of significant adverse events in gout patients with varying kidney function.
Conclusions:
- Current evidence does not support lowering serum uric acid to slow CKD progression or provide neuroprotection.
- Uric acid stones are primarily associated with low urinary pH, not necessarily high serum uric acid levels.
- Higher urate-lowering medication dosages may be feasible and warrant further investigation for potential CKD benefits.
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