Background/Aims: This study was designed to elucidate the clinical significance of serum uric acid (SUA) and the relationship between hyperuricemia and renal prognosis in IgA nepropathy. Methods: The correlation between SUA and other clinical parameters were examined in 748 IgA nephropathy patients (432 males and 316 females). Among these patients, 226 (144 males and 82 females) who were followed for more than 5 years were examined for the relationship between hyperuricemia and renal prognosis. Results: In IgA nephropathy, SUA correlated negatively with creatinine clearance (Ccr), and positively with urinary protein and tubulointerstitial damage. SUA was higher in patients with hypertension or diffuse proliferative glomerulonephritis. Hyperuricemia was a risk factor for renal prognosis, both in terms of serum creatinine (p = 0.0025) and Ccr (p = 0.0057). In 56 patients with normal Ccr at renal biopsy, the change of Ccr after more than 8 years was –22.3 ± 20.8% in 13 patients with hyperuricemia, compared with +2.6 ± 39.4% in 43 patients without hyperuricemia (p = 0.0238). Hyperuricemia was related independently to deterioration of Ccr (p = 0.0461). Conclusion: Hyperuricemia in IgA nephropathy is derived from both glomerular and tubulointerstitial damage, and correlated with hypertension. Hyperuricemia is a risk factor for renal prognosis in IgA nephropathy.

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Objective The purpose of this study was to investigate gouty arthritis in Japanese patients with end-stage renal disease (ESRD).Methods Questionnaires plus patient interviews and reviews of medical records were used to investigate gouty arthritis in 493 Japanese patients with ESRD receiving maintenance dialysis.Results The frequency of gouty arthritis was 4.1% for female patients and 15.4% for male patients greater than 2 years before the start of dialysis, and 0.6% for female patients and 7.7% for male patients less than 2 years before the start of dialysis. After the start of dialysis the frequency was 3.4% for the first 2 years and 1.2% thereafter in male patients, but no gouty arthritis appeared in female patients. Although the annual number of gouty attacks was 2.0±4.2 greater than 2 years before the start of dialysis, and 1.9±6.6 less than 2 years before the start of dialysis, the annual number of attacks decreased significantly after the start of dialysis to 0.2±0.7 in the first 2 years and 0.1±0.6 thereafter.Conclusions The frequency of gouty arthritis in Japanese patients with ESRD is similar to that of patients with hyperuricemia in the general population and it is decreased slightly before dialysis; however, the frequency decreases markedly after dialysis.

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Twenty patients with Vogt-Koyanagi-Harada disease who had been given systemic corticosteroids were retrospectively analyzed. Sixteen patients were successfully treated with systemic corticosteroids without recurrence of uveitis. Since the advent of corticosteroid treatment, there have been fewer ocular complications as well as extraocular sings and symptoms in most cases. Recurrence of the inflammation, however, occurred in four cases. Drip infusion of 200 mg prednisolone daily, widely employed for the treatment, did not always have good results. It is suggested that the dosage of corticosteroid should be adjusted according to the severity of uveomeningitis. Oral administration of corticosteroid (less than 100 mg prednisolone daily) may be enough for suppression of the inflammation in the Harada type, while a drip infusion of the massive dosage (more than 200 mg prednisolone daily) with gradual tapering off is possible requisite in the Vogt-Koyanagi type.

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