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Altered Serum Uric Acid Levels in Kidney Disorders
1Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea.
Life (Basel, Switzerland)
|November 26, 2022
Summary
Kidney disorders significantly impact serum uric acid levels, causing hyperuricemia or hypouricemia. Understanding these alterations is crucial for diagnosing and managing kidney diseases and related conditions like diabetes.
Area of Science:
- Nephrology
- Endocrinology
- Genetics
Background:
- Kidneys are central to uric acid excretion, making kidney disorders key influencers of serum uric acid levels.
- Hyperuricemia and hypouricemia are common in various kidney diseases, necessitating a deeper understanding of their pathophysiology.
- Uric acid's role in kidney health and disease is complex, involving excretion, reabsorption, and potential links to conditions like diabetes and genetic disorders.
Purpose of the Study:
- To review major kidney disorders associated with hyperuricemia and hypouricemia.
- To discuss the pathophysiology of these uric acid level alterations in kidney disease.
- To highlight the clinical implications of altered uric acid levels in conditions such as chronic kidney disease, diabetes, and genetic kidney diseases.
Main Methods:
- Literature review of major kidney disorders affecting uric acid levels.
- Analysis of the pathophysiology linking kidney dysfunction to hyperuricemia and hypouricemia.
- Synthesis of current clinical trial data and genetic findings related to uric acid metabolism in kidney disease.
Main Results:
- Chronic kidney disease (CKD) is frequently linked to hyperuricemia, though its pathogenic role in CKD progression is debated.
- Diabetes mellitus (DM) is associated with hyperuricemia; sodium-glucose cotransporter 2 inhibitors show uricosuric effects.
- Autosomal dominant tubulointerstitial kidney disease (ADTKD) mutations (UMOD, MUC-1) cause hyperuricemia and gout.
- Renal hypouricemia from URAT1/GLUT9 mutations increases acute kidney injury risk.
- Drug-induced Fanconi syndrome and hypouricemia in COVID-19 are linked to proximal tubular injury.
- Serum uric acid levels and fractional excretion reflect plasma volume status, with implications for hyponatremia and volume depletion.
Conclusions:
- Altered serum uric acid levels are significant indicators in various kidney disorders, from CKD and DM to genetic and drug-induced conditions.
- Understanding the complex interplay between kidney function, uric acid transport, and volume status is essential for clinical management.
- Further research into the molecular mechanisms of uric acid dysregulation in volume and water balance disorders is warranted.
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