Related Experiment Video

Updated: Jun 28, 2026

5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
05:34

5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats

Published on: April 4, 2025

Reconsidering Urate-Lowering Therapy in Chronic Kidney Disease- Guideline Driven Perspectives on the Management of

Sourabh Sharma1, Sabine Karam2, Intissar Haddiya3

  • 1Department of Nephrology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi.

JPMA. the Journal of the Pakistan Medical Association
|June 27, 2026
PubMed

Insights

Hyperuricaemia is common in chronic kidney disease (CKD). Current guidelines advise against urate-lowering therapy for asymptomatic cases due to lack of proven benefits.

Area of Science:

  • Nephrology
  • Rheumatology
  • Internal Medicine

Background:

  • Hyperuricaemia is prevalent in chronic kidney disease (CKD) patients, often due to impaired renal urate excretion.
  • Elevated serum uric acid (SUA) is associated with CKD progression, cardiovascular disease, and mortality, but causation is unproven.

Purpose of the Study:

  • To review current guideline recommendations and clinical trial evidence regarding urate-lowering therapy (ULT) in CKD patients.
  • To identify scenarios where initiating ULT is not recommended for patients with asymptomatic hyperuricaemia and CKD.

Main Methods:

  • Synthesis of current international guideline recommendations (KDIGO, ACR, EULAR).
  • Review of randomized clinical trial evidence on urate-lowering therapy in asymptomatic hyperuricaemia.
  • Analysis of practical clinical considerations for managing hyperuricaemia in CKD.

Main Results:

  • Multiple studies have not shown renoprotective or cardiovascular benefits of ULT in asymptomatic hyperuricaemia.
  • Major international societies recommend against pharmacologic treatment of asymptomatic hyperuricaemia in CKD patients.

Conclusions:

  • Pharmacologic urate-lowering therapy should generally not be initiated in patients with asymptomatic hyperuricaemia and CKD.
  • Focus should be on supportive and nonpharmacologic management strategies for these patients.

Keywords:
Hyperuricaemia, Chronic kidney disease, Asymptomatic hyperuricaemia, Urate-lowering therapy, Allopurinol, Febuxostat, Gout

Related Concept Videos

Urinary Tract Calculi IV: Nutrition Therapy and Prevention01:27

Urinary Tract Calculi IV: Nutrition Therapy and Prevention

Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
Urinary Tract Calculi III: Medical Management01:30

Urinary Tract Calculi III: Medical Management

The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
Urinary Tract Calculi V: Nursing Management01:28

Urinary Tract Calculi V: Nursing Management

AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Nephrotic Syndrome II : Assessment and Medical Management01:26

Nephrotic Syndrome II : Assessment and Medical Management

IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document any history...