Uric acid metabolism in a sample of Egyptian hypertensive patients with normal kidney function

Hyperuricemia is commonly associated with hypertension. Also, it is well known to coincide with the metabolic syndrome but is still not recognized as a risk factor. So, we aimed to evaluate hyperuricemia among a sample of hypertensive Egyptians with normal renal function. This study was performed on 303 hypertensive patients aged 30-69 years. Patients were divided into 2 groups according to the level of uric acid: group 1 composed of 168 hypertensive hyperuricemic patient sand group 2 composed of 135 hypertensive normouricemic patients. All patients were subjected to complete medical history and detailed clinical examination including body mass index [BMI], complete blood count [CBC], serum creatinine, BUN, FBS, cholesterol, triglycerides, uric acid, sodium, potassium, urinary uric acid, urinary creatinine, urinary uric acid to creatinine ratio and fractional excretion of uric acid[FEUA]. The overall prevalence of hyperuricemia was 55.4%. Uric acid correlated significantly with age [p<0.05]. BMI was significantly higher in group1 than in group 2 [p<0.05], and there was a significant positive correlation between serum uric acid and BMI [p<0.01].Serum triglycerides and cholesterol were significantly higher in group 1 than in group 2 [p<0.05for both] denoting risky metabolic effects. Serum uric acid correlated significantly with systolic blood pressure [p<0.05], but not with diastolic blood pressure. No significant difference found between group 1 and group 2 as regards SBP, DBP or blood pressure control [all p values > 0.05]. Serum uric acid found to correlate significantly [p<0.001] with urinary uric acid, urinary creatinine and negatively with FEUA denoting early tubular defect of the kidney. Also, Urinary uric acid, urinary creatinine and urinary uric acid/creatinine ratio were higher in group 1than in group 2 [p values were<0.001, <0.001 and <0.05 respectively]. FEUA was found to be significantly lower in group 1 than in group 2 [p<0.01]. We found, also, that serum sodium level was significantly higher in the hyperuricemic group than in the normouricemic group [p<0.001] denoting the role of Na[+] in the development of hypertension and defective renal excretion of uric acid. We conclude that the incidence hyperuricemia in our sample of Egyptian hypertensive patients was [55.4%]. Impaired renal clearance of uric acid occurs before deterioration of GFR. Serum uric acid should be measured in all cases of hypertension together with BMI, total cholesterol, triglycerides and should be treated to avoid consequent metabolic complications. Hypertensive patients with hyperuricemia should be warned strictly of high sodium diet

Impact of hyperuricemia on cardiovascular system in ESRD patients

Hyperuricemia was found to be associated with hypertension, coronary heart disease, metabolic syndrome and chronic kidney disease. However there are no specific data about the relationship of uric acid to cardiovascular disease and mortality in ESRD patients on chronic hemodialysis. So, we aimed to study the impact of hyperuricemia on cardiovascular system in chronic kidney disease and in ESRD patients on regular hemodialysis. This study included 100 patients in Ashmoun hospital, nephrology department. Patients were chosen and divided into two groups: Group A, 50cases with chronic kidney disease and Group B, 50cases of ESRD on regular hemodialysis. All cases were subjected to full clinical examination, measurement of eGFR, laboratory tests for blood urea, serum creatinine and serum uric acid and ECG. Serum uric acid was significantly higher in dialysis group than CKD group [p<0.01]. There was a highly significant correlation between uric acid and both systolic and diastolic blood pressure in Group A [all p values <0.01]. Also, there was a significant correlation between serum uric acid and eGFR [p<0.05].No significant difference found between Group A and group B as regards ECG findings [p>0.05]. In cases of CKD uric acid is involved in the pathogenesis of renal failure and hypertension. In patients with ESRD, hyperuricemia is not a risk factor for the development of cardiac disease; but it shows reversed epidemiology and becomes a marker of good nutritious status. Further studies should be done on wider scales to evaluate the impact of hyperuricemia on cardiovascular system in hemodialysis patients

Oxidative stress and cardiovascular diseases risk factors in hepatitis C infected hemodialysis patients

Oxidative stress which is defined as a disturbance of the normal balance between oxidants and antioxidants in the body, play a key role in accelerated atherosclerosis and to be involved in cardiovascular diseases [CVD] of dialyzed patients who are at the risk of increased oxidative stress. is to evaluate the effect of hepatitis C virus [HCV] infection and dialysis on oxidative stress markers Malondialdehyde [MDA], and its effect on increased CVD in HCV positive hemodialysis [HD]. 60 adults on maintenance HD patients were divided into 4 groups: group-I: 15 patients positive to HCV Ab with no clinical evidence of CVD; group-II: 15 patients positive to HCV Ab with clinical evidence of CVD; group-III: 15 dialysis patients negative to HCV Ab with no clinical evidence of CVD; group-IV: 15 dialysis patients negative to HCV Ab with history of different CVD and Group V: 15 healthy control subjects. all patients were subjected to: full history and clinical examination, CXR, ECG, Echocardiography, routine laboratory investigations eg; BUN, creatinine, Lipid profile, ALT, AST, Albumin and measurement of serum MDA. MDA increase in all groups in comparison to control.- There is a strong correlation between MDA and CVD risk factors in groups II and IV than in other groups.- MDA increase with increasing years of dialysis.- There is a strong correlation between MDA and ALT in group-I and n and no correlation in groups III and IV. HD treatment is associated with rises in oxidative stress marker and the infection of HCV increases this effect. Oxidative stress is a strong factor in development of CVD in HD patients