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Rheumatology Advance Access published online on April 27, 2008

Rheumatology, doi:10.1093/rheumatology/ken070
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Review

Hyperuricaemia—where nephrology meets rheumatology

Z. Avram and E. Krishnan

Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

Correspondence to: E. Krishnan, Division of Rheumatology, Stanford University, 1000 Welch Road, Suite 203, Palo Alto CA 94304, USA. E-mail: e.krishnan{at}stanford.edu


   Abstract

Rheumatologists care for patients with gouty arthritis, a condition caused by chronic and uncontrolled hyperuricaemia. Hyperuricaemia, gout and renal dysfunction are often bedfellows, raising the possibility of the former causing the latter. We sought the answer to the question ‘Among patients with normal measures of glomerular filtration, does hyperuricaemia predict future renal disease’? We identified prospective cohort studies evaluating the relationship between serum uric acid and chronic kidney function from the past 20 yrs, through MEDLINE, Cochrane Library and EMBASE searches and bibliography cross-referencing. Nine cohort studies that met the selection criteria were found. Because of the extreme heterogeneity, a statistical meta-analysis was not performed. Most (eight out of nine) studies found an independent risk factor for deterioration of kidney function. Nearly all published prospective studies support the role of hyperuricaemia as an independent risk factor for renal dysfunction. In the absence of large randomized controlled trials of uric acid reduction, it remains uncertain if this relation is causal or merely an epiphenomenon. Regardless, our review suggests that hyperuricaemia is a useful, inexpensively measured, widely available and useful early marker for chronic kidney disease.

KEY WORDS: Uric acid, Creatinine, Renal failure, Kidney disease

Submitted 31 August 2007; revised version accepted 30 January 2008.
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