Uric Acid in Hypertension and Renal Disease: The Chicken or the Egg

Abstract

After uric acid was recognized as the causative factor in gout, increased prevalence of renal disease and hypertension in this patient population caught the attention of the medical community. Thus, it has been proposed that uric acid might have caused these disorders. However, uric acid suffered a long period of ignorance in which it was considered a metabolically inert substance. However, recent years has witnessed a resurrection of interest. Experimental studies showed an association between increased uric acid and renal arteriolar disease and hypertension. These preliminary results were supported with clinical studies. However, controversy regarding the precise pathophysiologic role of uric acid in inducing hypertension and renal disease remains to be elucidated. Despite being limited at this time, a few randomized intervention studies showed that even treatment of asymptomatic hyperuricemia was beneficial in terms of blood pressure regulation and kidney function. In this review, we focus on the pathophysiologic role of uric acid in the development and progression of renal disease and hypertension. We also discuss recent clinical evidence suggesting a causal role of uric acid in these disease states.

Lipid Peroxidation and Antioxidants in Arterial Hypertension

“…Second, in biological fluids, uric acid appears to account for more than 50% of the total antioxidant activity measured in most assays [108]. However, the putative protective effect of uric acid is debatable [140,141].…”

Increased Uric Acid Promotes Decline of the Renal Function in Hypertensive Patients: A 10-year Observational Study

“…Hyperuricemia has also shown to be closely related to the development and progression of chronic kidney disease (CKD) (5,(8)(9)(10)(11)(12)(19)(20)(21)(22)(23)(24)(25)(26). Gouty kidney with UA crystal deposition is known to be a complication of hyperuricemia.…”

“…It is well known that renal dysfunction causes hyperuricemia. However, evidence is accumulating that hyperuricemia itself causes arteriolosclerosis and/or interstitial damage of the kidneys without intrarenal UA crystal deposition, unlike the classic gouty kidney observed following UA crystal deposition (8)(9)(10)(11)(12)(13). In the present study, therefore, we investigated the relationship between changes in the serum UA level and the renal function in hypertensive patients over a 10-year observation period.…”

Hyperuricemia and severity of coronary artery disease: An observational study in adults 35 years of age and younger with acute coronary syndrome

“…The NCEP ATP III criteria [8] for the metabolic syndrome were used to diagnose study participants with metabolic syndrome. Based on published clinical guidelines, SUA levels ≥ 7.0 mg/dL (420 μmol/L) in males and ≥ 6.0 mg/dL (357 μmol/L) in females were defined as HUA [9]. A personal history of HTN and DM, a family history of CAD, cigarette smoking, and alcohol consumption were collected from electronic medical records.…”