Effects of hyperuricemia on incident renal replacement therapy and all-cause mortality among patients with chronic kidney disease stages 3-5: a retrospective cohort study

ABSTRACT BACKGROUND: Findings regarding the effects of hyperuricemia on renal function and mortality have been inconsistent. OBJECTIVES: To investigate the effects of hyperuricemia on incident renal replacement therapy and all-cause mortality among patients with chronic kidney disease (CKD). DESIGN AND SETTING: Retrospective cohort study conducted in a medical center in Taiwan. METHODS: Patients with CKD in stages 3-5, without histories of renal replacement therapy, were consecutively recruited from 2007 to 2013. Their medical history, laboratory and medication data were collected from hospital records. The mean uric acid level in the first year of follow-up was used for analyses. Hyperuricemia was defined as mean uric acid level ≥ 7.0 mg/dl in men or ≥ 6.0 mg/dl in women. The primary outcomes were incident renal replacement therapy and all-cause mortality, and these data were retrospectively collected from hospital records until the end of 2015. RESULTS: A total of 4,381 patients were analyzed (mean age 71.0 ± 14.8 years; males 62.7%), and the median follow-up period was 2.5 years. Patients with hyperuricemia were at increased risk of incident renal replacement therapy and all-cause mortality, especially those with CKD in stages 4 or 5. Compared with patients with CKD in stage 3 and normouricemia, patients with CKD in stages 4 or 5 presented significantly higher risk of all-cause mortality only if they had hyperuricemia. CONCLUSIONS: In patients with CKD in stages 3-5, hyperuricemia was associated with higher risk of incident renal replacement therapy and all-cause mortality. Whether treatment with uric acid-lowering drugs in these patients would improve their outcomes merits further investigation.

Serum Uric Acid Levels are Associated with Cardiometabolic Risk Factors in Healthy Young and Middle-Aged Adults / Os Níveis Séricos de Ácido Úrico estão Associados a Fatores de Risco Cardiometabólico em Adultos Jovens e de Meia-Idade Saudáveis

Abstract Background: Observational studies have highlighted an association between serum uric acid (SUA) levels and cardiovascular risk factors. Despite the growing body of evidences, several studies were conducted in older individuals or in carriers of diseases susceptible to affect SUA levels and cardiometabolic risk markers. Objective: To evaluate the relationship of SUA with body adiposity, metabolic profile, oxidative stress, inflammatory biomarkers, blood pressure and endothelial function in healthy young and middle-aged adults. Methods: 149 Brazilian adults aged 20-55 years, both sexes, underwent evaluation of body adiposity, SUA, fasting glucose and insulin, lipid profile, malondialdehyde (MDA), high sensitivity C-reactive protein (hs-CRP), adiponectin, blood pressure and endothelial function. Endothelial function was assessed by the reactive hyperemia index (RHI) derived from peripheral arterial tonometry method. Participants were allocated in two groups according to SUA levels: control group (CG; n = 130; men ≤ 7 mg/dL, women ≤ 6 mg/dL) and hyperuricemia group (HG; n = 19; men > 7 mg/dL, women > 6 mg/dL). A P-value < 0.05 was considered statistically significant. Results: After adjustment for confounders, participants in HG compared with those in CG displayed higher body mass index (BMI): 34.15(33.36-37.19) vs.31.80 (26.26-34.42) kg/m2,p = 0.008, higher MDA: 4.67(4.03-5.30) vs. 3.53(3.10-4.07) ng/mL, p < 0.0001 and lower RHI: 1.68 ± 0.30 vs. 2.05 ± 0.46, p = 0.03). In correlation analysis adjusted for confounders, SUA was positively associated (p < 0.05) with BMI, waist circumference, LDL-cholesterol, triglycerides and MDA, and negatively associated (p < 0.05) with HDL-cholesterol, adiponectin and RHI. Conclusions: This study suggests that in healthy young and middle-aged adults higher SUA levels are associated with higher body adiposity, unfavorable lipid and inflammatory phenotype, higher oxidative stress and impaired endothelial function.

Resumo Fundamento: Estudos observacionais têm destacado uma associação entre níveis de ácido úrico sérico (AUS) e fatores de risco cardiovascular. Apesar do crescente conjunto de evidências, vários estudos foram realizados em indivíduos mais velhos ou em portadores de doenças passíveis de influenciar os níveis de AUS e marcadores de risco cardiometabólico. Objetivo: Avaliar a relação do AUS com adiposidade corporal, perfil metabólico, estresse oxidativo, biomarcadores de inflamação, pressão arterial e função endotelial em adultos jovens e de meia-idade saudáveis. Métodos: 149 adultos, brasileiros, com idades entre 20 e 55 anos, de ambos os sexos, foram submetidos a avaliação de adiposidade corporal, AUS, glicose e insulina de jejum, perfil lipídico, malondialdeído (MDA), proteína C-reativa ultra-sensível (PCR-us), adiponectina, pressão arterial e função endotelial. A função endotelial foi avaliada pelo índice de hiperemia reativa (RHI) derivado do método de tonometria arterial periférica. Os participantes foram divididos em dois grupos de acordo com os níveis de AUS: grupo de controle (GC; n = 130; homens ≤ 7 mg/dL, mulheres ≤ 6mg/dL) e grupo de hiperuricemia (GH; n = 19; homens > 7mg/dL, mulheres > 6mg/dL). Valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: Após ajuste para fatores de confundimento, os participantes do GH comparados aos do GC apresentaram índice de massa corporal (IMC) mais alto: 34,15 (33,36-37,19) vs. 31,80 (26,26-34,42) kg/m2, p = 0,008, MDA mais alto: 4,67(4,03-5,30) vs. 3,53(3,10-4,07) ng/mL, p < 0,0001 e RHI mais baixo: 1,68 ± 0,30 vs. 2,05 ± 0,46, p = 0,03. Na análise de correlação ajustada para fatores de confundimento, o AUS se associou positivamente (p < 0,05) com IMC, circunferência da cintura, LDL colesterol, triglicérides e MDA, e se associou negativamente (p < 0,05) com HDL colesterol, adiponectina e RHI. Conclusões: Este estudo sugere que, em adultos jovens e de meia-idade saudáveis, níveis mais altos de AUS estão associados a maior adiposidade corporal, fenótipo inflamatório e de lipídios desfavorável, maior estresse oxidativo e função endotelial comprometida.

Serum uric acid levels and hyperuricemia in patients with psoriasis: a hospital-based cross-sectional study

Abstract: A hospital-based cross-sectional study was performed, including 117 psoriatic patients and 117 controls matched for age, gender, and body mass index. Psoriatic patients had higher levels of serum uric acid (6.25 ± 1.62 vs 5.71 ± 1.35 mg/dl; P=0.019) and significantly greater prevalence of hyperuricemia (31.6% vs 16.2%; P=0.009) than individuals without psoriasis. Psoriatic patients had significantly higher serum uric acid than controls in subjects without metabolic syndrome. Multivariate logistic regression analysis showed that psoriasis can be a strong predictor of hyperuricemia (odds ratio 2.61; 95% confidence interval 1.34-5.00; P=0.004).

Critical revision of the medical treatment of gout in Brazil / Revisão crítica do tratamento medicamentoso da gota no Brasil

ABSTRACT Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems.

RESUMO A gota é considerada a forma mais comum de artrite inflamatória em homens acima de 40 anos. Os autores apresentam uma breve revisão sobre o tratamento atual da gota e discutem as limitações farmacológicas existentes no Brasil para o tratamento dessa enfermidade. Apesar de o alopurinol ainda ser a principal medicação para a redução dos níveis de uricemia de pacientes com gota no país, os autores também apresentam dados que apontam para uma grande oportunidade para o mercado farmacológico brasileiro em relação ao tratamento da hiperuricemia e da artrite gotosa e especialmente para pacientes usuários de sistemas privados de saúde e do SUS (Sistema Único de Saúde).

Relationship between uric acid levels and risk of chronic kidney disease in a retrospective cohort of Brazilian workers

Uric acid (UA) levels are increased in patients with kidney dysfunction. We analyzed the association between asymptomatic hyperuricemia and new-onset chronic kidney disease (CKD). A retrospective cohort study was designed to collect data from employees of an energy generation and distribution company in the city of Rio de Janeiro, Brazil, who had undergone the company's annual medical checkup from 2008 to 2014. People with ≤2 years of follow-up, with baseline estimated glomerular filtration rate (eGFR) <60 mL·min-1·(1.73 m2)-1 or with incomplete data were excluded. The endpoint was defined as eGFR <60 mL·min-1·(1.73 m2)-1 estimated through the chronic kidney disease epidemiology collaboration equation (CKD-EPI). The study included 1094 participants. The mean follow-up period was 5.05±1.05 years and 44 participants exhibited new-onset CKD. The prevalence of hyperuricemia was 4.2%. There was a significant inverse correlation between baseline serum levels of UA and baseline eGFR (R=-0.21, P<0.001). Female gender (OR=4.00; 95%CI=1.92-8.29, P<0.001) and age (OR=1.06; 95%CI=1.02-1.11, P=0.004) but not UA levels (OR=1.12; 95%CI=0.83-1.50; P=0.465) were associated with new-onset CKD. Diabetes mellitus and body mass index were independent factors for fast progression (OR=2.17; 95%CI=1.24-3.80, P=0.007 and OR=1.04; 95%CI=1.01-1.07; P=0.020). These results did not support UA as an independent predictor for CKD progression in the studied population.

Relation between uric acid and metabolic syndrome in subjects with cardiometabolic risk / Relação entre ácido úrico e síndrome metabólica em uma população com risco cardiometabólico

Objective To identify possible relations between serum uric acid levels and metabolic syndrome and its components in a population with cardiometabolic risk. Methods This cross-sectional study included 80 subjects (46 women), with mean age of 48±16 years, seen at the Cardiovascular Health Program. Results The prevalence of hyperuricemia and metabolic syndrome was 6.3% and 47.1%, respectively. Uric acid level was significantly higher in individuals with metabolic syndrome (5.1±1.6mg/dL), as compared to those with no syndrome or with pre-syndrome (3.9±1.2 and 4.1±1.3mg/dL, respectively; p<0.05). The uric acid levels were significantly higher in men presenting abdominal obesity, and among women with abdominal obesity, lower HDL-c levels and higher blood pressure (p<0.05). Conclusion Uric acid concentrations were positively related to the occurrence of metabolic syndrome and its components, and there were differences between genders. Our results indicate serum uric acid as a potential biomarker for patients with cardiometabolic risk. .

Objetivo Identificar as possíveis relações da concentração sérica de ácido úrico com a síndrome metabólica e seus componentes em uma população com risco cardiometabólico. Métodos Estudo transversal que incluiu 80 indivíduos (46 mulheres), com média de idade de 48±16 anos, atendidos pelo Programa de Atenção à Saúde Cardiovascular. Resultados As prevalências de hiperuricemia e de síndrome metabólica foram 6,3% e 47,1%, respectivamente. A concentração de ácido úrico foi significantemente maior entre os sujeitos com síndrome metabólica (5,1±1,6mg/dL), comparada a daqueles sem a síndrome ou com pré-síndrome (3,9±1,2 e 4,1±1,3mg/dL, respectivamente; p<0,05). A concentração de ácido úrico foi maior entre homens com obesidade abdominal, e entre mulheres com obesidade abdominal, menores concentrações de HDL-c e maior pressão arterial (p<0,05). Conclusão As concentrações de ácido úrico foram positivamente relacionadas com a ocorrência de síndrome metabólica, bem como de seus componentes, para os quais foram observadas diferenças entre os sexos. Nossos resultados indicam a importância do ácido úrico como biomarcador em pacientes com risco cardiometabólico. .

Relationship between Serum Uric Acid Concentration and Acute Kidney Injury after Coronary Artery Bypass Surgery

An elevated serum concentration of uric acid may be associated with an increased risk of acute kidney injury (AKI). The aim of this study was to investigate the impact of preoperative uric acid concentration on the risk of AKI after coronary artery bypass surgery (CABG). Perioperative data were evaluated from patients who underwent CABG. AKI was defined by the AKI Network criteria based on serum creatinine changes within the first 48 hr after CABG. Multivariate logistic regression was utilized to evaluate the association between preoperative uric acid and postoperative AKI. We evaluated changes in C statistic, the net reclassification improvement, and the integrated discrimination improvement to determine whether the addition of preoperative uric acid improved prediction of AKI. Of the 2,185 patients, 787 (36.0%) developed AKI. Preoperative uric acid was significantly associated with postoperative AKI (odds ratio, 1.18; 95% confidence interval, 1.10-1.26; P<0.001). Adding uric acid levels improved the C statistic and had significant impact on risk reclassification and integrated discrimination for AKI. Preoperative uric acid is related to postoperative AKI and improves the predictive ability of AKI. This finding suggests that preoperative measurement of uric acid may help stratify risks for AKI in in patients undergoing CABG.

Transición epitelio-mesenquimática renal en un modelo experimental de Heperuricemia: participación de Nalp-3 y sus funciones canónicas y no-canónicas / Renal epithelial-mesenchymal transition in an experimental model of Hyperuricemia: participation Nalp-3 and its canonical and non-canonical functions

La fibrosis renal y la consecuente pérdida de las funciones del riñón son elementos comunes en la enfermedad renal crónica. La transición epitelio mesenquimatica (TEM) representa estadios tempranos del proceso de fibrosis. Recientemente se ha vinculado a la inmunidad innata en los procesos de injuria y fibrosis renal. Los pacientes con hiperuricemia presentan una mayor progresión a la enfermedad renal crónica, y mayor prevalencia de hipertensión arterial, induciendo fibrosis renal en modelos animales. No se conoce la participación de la inmunidad innata en la injuria renal inducida por ácido úrico. Para conocer la participación de la inmunidad innata en los procesos de TEM y fibrosis renal inducidos por ácido úrico se recurrió a un modelo desarrollado en rata Wistar macho con elevados niveles de ácido úrico (AOX+U). Para esto se suplementó la dieta con ácido oxónico al 2% (inhibidor de uricasa) y ácido úrico 2% durante 7 semanas. Dos grupos controles fueron considerados para comparar los hallazgos, un grupo con dieta estándar sin los agregados (C) y un segundo grupo control con suplemento de ácido oxónico y úrico, y además allopurinol en agua de bebida (ALL). Los niveles de ácido úrico y urea fueron testeados durante el tratamiento. A las 7 semanas los animales fueron sometidos a eutanasia y tejido renal fue obtenido para análisis de expresión proteica, análisis histológicos (fotónico y electrónico de transmisión) y para estudio mitocondrial: actividad de complejos de cadena respiratoria y respirometria de alta resolución mitocondrial.

SUMMARY: Chronic kidney disease (CKD) is associated with renal fibrosis and loss of kidney functions. Epithelial to mesenchimal transition (EMT) represents early stages of fibrosis. Currently the innate immunity has been associated with kidney injury and fibrosis. Hyperuricemic patients have more progression to CKD and higher prevalence of hypertension. Animals models have shown renal fibrosis induced by uric acid. It is not known the role of innate immunity in the uric acid induced damage in kidney. To describe the participation of the innate immunity in EMT and kidney fibrosis induced by uric acid we used a rat model with higher plasma levels of uric acid uric (AOX-U). These rats were feeding with oxonic acid 2% and uric acid 2% in regular chow during 7 weeks. Two control groups were included, “control group” (C) receiving regular chow without the supplements and the “ALL” group receiving not only the oxonic and uric acid supplement but also allopurinol in drinking water. The plasmatic uric acid and urea levels were checked during the follow-up. At 7 weeks the animals were euthanized and kidney tissue was harvested to protein expression analysis, histology and mitochondrial physiologic studies.

Association of asymptomatic hyperuricemia and endothelial dysfunction in psoriatic arthritis

Cardiovascular disease is an increasingly recognized contributor to excess morbidity and mortality in psoriatic arthritis [PsA]. Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular disease in PsA. To examine the prevalence of subclinical atherosclerosis in patients with PsA to emphasize the potential role of serum uric acid on endothelial dysfunction, as an early predictor for atherosclerosis in PsA patients. This study included 60 PsA patients as well as 60 age and sex matched healthy controls. Assay of serum uric acid, interleukin-6 [IL-6] and soluble intercellular adhesion molecule-1 [sICAM-1] was done for all patients and controls. Patients were subjected to psoriasis area severity index [PASI] and assessment of disease activity. Patients and controls underwent brachial flow-mediated dilatation [FMD] assessment by color duplex sonography to determine endothelial dysfunction as well as extracranial carotid arteries assessment by high-resolution B-mode ultrasound to measure the common carotid intima-media thickness [CIMT] and the detection of atheromatous plaques. PsA patients have a high significant difference in CIMT, FMD of the brachial artery and mean levels of serum uric acid compared to healthy controls [p < 0.001]. PsA patients with hyperuricemia have a high significant difference in CIMT and FMD of the brachial artery than those with normal serum uric acid. Serum uric acid levels showed a high significant positive correlation with each of CIMT, disease duration, markers of inflammation [ESR, CRP, IL-6, sICAM-1], disease activity score in 28 joints [DAS 28] and PASI [r = 0.71, 0.893, 0.956, 0.858, 0.853, 0.877, 0.907, 0.847, respectively, as p < 0.001]. A high significant negative correlation was found between serum uric acid levels and FMD of the brachial artery as r = -0.634, p < 0.001. Patients with PsA have a high prevalence of subclinical atherosclerosis dependent on serum uric acid, suggesting that chronic systemic inflammation and endothelial dysfunction appear to be the link between asymptomatic hyperuricemia and atherosclerosis. Therefore, proper control of serum uric acid may play a preventive role in the development of atherosclerosis in PsA patients

Association Between Serum Uric Acid Level and Metabolic Syndrome / 예방의학회지

OBJECTIVES: Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the association of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea. METHODS: We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38 to 87) who participated in baseline examinations of the Korean Genome and Epidemiology Study: Kanghwa study. Blood samples were collected after at least an 8 hour fast. Uric acid quartiles were defined as follows: or =6.5 mg/dL in males; and or =5.1 mg/dL in females. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III Criteria with adjusted waist circumference cutoffs (90 cm for males; 80 cm for females). The association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression. RESULTS: The odds ratio for having metabolic syndrome in the highest versus lowest quartiles of serum uric acid levels was 2.67 (95% confidence interval [CI], 1.60 to 4.46) in males and 2.14 (95% CI, 1.50 to 3.05) in females after adjusting for age, smoking, alcohol intake, body mass index, total cholesterol, HbA1c, albumin, gamma-glutamyltransferase, blood urea nitrogen, and log C-reactive protein. The number of metabolic abnormalities also increased gradually with increasing serum uric acid levels (adjusted p for trend < 0.001 in both sexes). CONCLUSIONS: Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.

Association of Renal Manifestations with Serum Uric Acid in Korean Adults with Normal Uric Acid Levels

Several studies have reported that hyperuricemia is associated with the development of hypertension and cardiovascular disease. Increasing evidences also suggest that hyperuricemia may have a pathogenic role in the progression of renal disease. Paradoxically, uric acid is also widely accepted to have antioxidant activity in experimental studies. We aimed to investigate the association between glomerular filtration rate (GFR) and uric acid in healthy individuals with a normal serum level of uric acid. We examined renal function determined by GFR and uric acid in 3,376 subjects (1,896 men; 1,480 women; aged 20-80 yr) who underwent medical examinations at Gangnam Severance Hospital from November 2006 to June 2007. Determinants for renal function and uric acid levels were also investigated. In both men and women, GFR was negatively correlated with systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, uric acid, log transformed C reactive protein, and log transformed triglycerides. In multivariate regression analysis, total uric acid was found to be an independent factor associated with estimated GFR in both men and women. This result suggests that uric acid appears to contribute to renal impairment in subjects with normal serum level of uric acid.

The relationship of hyperuricemia and blood pressure in the Thai army population.

BACKGROUND: Previous studies have demonstrated a strong association of hypertension and renal disease with gout. Nevertheless, controversy remains concerning serum uric acid concentration as an independent factor of hypertension. AIM: To explore the relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with serum uric acid levels. SETTINGS AND DESIGN: An observational study. MATERIALS AND METHODS: A total of 5,564 subjects from the Armed Forces Research Institute of Medical Sciences were included in the study. STATISTICAL ANALYSIS: ANOVA tests, Chi-square test, correlation coefficients, and multiple regression analysis were performed. RESULTS: Of the total subjects, 4,099 (73.7%) were male. Mean SBP and DBP were 128.73+/-17.06 and 81.62 +/- 11.58 mm Hg, respectively. The mean serum uric acid level was 6.54 +/- 1.71 mg/dL. A significant and positive correlation was found both between serum uric acid and SBP (r=0.186, P P CONCLUSIONS: In this study, we suggest that serum uric acid be used to correlate with levels of blood pressure in the general population. Further investigation is required to establish the treatment for hyperuricemia in hypertensive patients.

Serum calcium, magnesium and uric acid in preeclampsia and normal pregnancy.

OBJECTIVE: To compare serum calcium, magnesium and uric acid in mild, severe preeclamptic women and normal pregnant women. STUDY DESIGN: Cross-sectional study. Setting: Section of Obstetrics and Gynecology, Taksin Hospital. MATERIAL AND METHOD: The data was collected from 36 normal pregnant women, 35 mild preeclamptic women and 33 severe preeclamptic women who were admitted in the Section of Obstetrics and Gynecology at Taksin Hospital between April 2006 and June 2007. The blood samples were collected and analyzed for calcium, magnesium and uric acid The data was analyzed using Analysis of Variances (ANOVA). RESULTS: The serum calcium in severe preeclamptic women was significantly lower (8.7 +/- 0.59 mg/dl vs. 8.99 +/- 0.31 mg/dl, p = 0.045; and 9.05 +/- 0.52 mg/dl, p = 0 014) and serum uric acid was significantly higher (7.01 +/- 1.93 mg/dl vs. 5.33 +/- 1.23 mg/dl, p < 0.001 and 5.95 +/- 1.9 mg/dl, p = 0.044) than in normal pregnant women and mild preeclamptic women respectively, but there was no difference between normal and mild preeclamptic women. There was no difference in serum magnesium among normal pregnancy and both groups of preeclampsia. CONCLUSION: Hypocalcemia and hyperuricemia correlated to severe preeclampsia.

significance of hyperuricemia in gestational hypertension and preeclampsia

Hyperuricemia [HU = serum uric acid >6mg/dl] seems to be related to the adverse perinatal outcomes in gestational hypertension [GH] and preeclampsia [PE]. The aim of our work is to verify this relation. A case-control study was performed on 50 normal pregnant patients, 69 cases of GH and 106 PE admitted to hospital for delivery. They were assigned into 7 categories: 50 normal pregnancies, 38 cases of GH without HU, 31 cases of GH with HU 36 cases of mild PE without HU, 32 cases of mild PE with HU, 18 cases of severe PE without HU and 20 cases of severe PE with HU. All participants were primiparous with no known medical complications. Serum uric acid was estimated on admission for delivery in all categories. The frequency of preterm birth, gestational age at delivery, infant birth weight, rate of admission to the neonatal intensive care unit [NICU] and perinatal mortality were reported in the seven categories. Mean serum uric acid concentrations in normal pregnancy, GH, PE were 3.8 +/- 0.8 mg/dl, 6.9 +/- 0.6 mg/dl and 7.8 +/- 0.6 mg/dl respectively [P<0.001]. The systolic BP, diastolic BP, gestational age at delivery, infant birth weight admission to NICU and perinatal mortality [PNM] in different studied groups were: in GH without HU and GH with HU were 148 +/- 6 vs 149 +/- 2 mmHg [P>0.05], 93 +/- 5 vs 94 +/- 6 mmHg [P>0.05], 39,2 +/- 2 vs 34,1 +/- 2 weeks [P<0.01], 3402 +/- 110 vs 2761 +/- 100 gm [P<0.01], 10.52 vs32.3% [P<0.05] and 0 vs 12,9% [P<0.05] respectively. In mild PE without HU and mild PE with HU the previous items were; 149 +/- 6.1 vs 150 +/- 4.8 mmHg [P>0.05],94 +/- 4.1 vs 96.28 mmHg [P>0.05], 38.6 +/- 2.1 vs 33.5 +/- 1.6 weeks [P<0.01],3044 +/- 096 vs 2762 +/- 101 gm [P<0.01].11.11 vs 43.75% [P<0.01] and 0 vs 6.25% [P>0.05] respectively. In severe PE without HU and severe PE with HU the previous items were: 170 +/- 8.2 vs 172 +/- 3.1 mmHg [P>0.05], 110 +/- 6.8 vs12 +/- 8.8 mmHg [P>0.05], 36.8 +/- 1.1 vs 33.2 +/- 1.2 weeks [P<0.1], 2751 +/- 101 vs 2410 +/- 106 gm [P<0.01], 11.11 vs 40.0% [P<0.05] respectively. No relationship was found between the seric uric acid concentration and the severity of PE including the level of the blood pressure [BP], thrombocytopenia and the level of liver enzymes. However, there is a direct relation between HU and the adverse perinatal outcomes: lower gestational age at delivery, smaller birth weight and increased rate of admission to NICU, in GH and PE

Shock wave lithotripsy treatment of radiolucent renal stones: a simple alternative

Objective: To evaluate a simple procedure for dealing with radiolucent renal pelvic stones larger than 2cm using combined ureteric catheter [for stone localization] and double-J stent [for prophylaxis of stein-strasse] prior to shock wave lithotripsy [SWL]

Methods: Thirty-five patients [21 males and 4 females] with single radiolucent stone in the renal pelvis were entered in this study in the period from Feb. 2003 to March 2007. The average stone size was 25mm [range from 20 to 30 mm]. Patients underwent initial ureteric catheter insertion followed by double-J stent and referred to SWL unit. The stone localized by contrast medium injected in the catheter throughout the lithotripsy session then the catheter was removed leaving the stent. Patients were followed up 10 days post lithotripsy by ultrasonography and I.V.P or non contrast spiral C.T scanning to detect the residual stones

Results: The success rate was 91% [32 patients] 10 days after lithotripsy. Three patients [9%] showed significant residual fragments. Those patients required oral chemolysis for stone dissolution. There was no adverse reactions of contrast medium and there was no significant complications intra or post-operatively

Conclusion: Shock wave lithotripsy for radiolucent renal pelvic stones with help of contrast medium injected through a ureteric catheter is a minimally invasive technique with a high success rate. It can be considered as a simple alternative to traditional treatment modalities for radiolucent stones

The serum uric acid and related cardiovascular risk factors in south Taiwan.

Hyperuricemia has been shown to be related to cardiovascular morbidity and mortality. Uric acid is a metabolic product synthesized from nucleic acids, amino acids and the Krebs cycle, reflecting a multiple metabolic associations in humans. The relation between uric acid and various cardiovascular metabolic parameters in Asians has rarely been reported on. In this study, we report the relationship between uric acid and various cardiovascular risk factors in 1,027 healthy Taiwanese adults living in Alien, an agricultural town in subtropical South Taiwan. Serum uric acid levels increased in proportion to age in women, but not in men. There were age and gender-specific correlations between uric acid and various cardiovascular metabolic parameters. Triglycerides and creatinine levels were two independent factors predicting serum uric acid levels in men, while only creatinine predicted uric acid levels in women of all age groups. Processes that influence the metabolism of uric acid and its association with other metabolic parameters differs by gender and age.

Valor pronóstico de la hiperuricemia en la insuficiencia cardiaca crónica / Prognostic value of hyperuricemia in chronic heart failure

BACKGROUND: Hyperuricemia has been proposed as a risk marker in chronic heart failure, but its value as an independent prognostic is not well established. AIM: To determine the prognostic value of hyperuricemia, in patients with chronic stable heart failure. PATIENTS AND METHODS: Forty six male patients with chronic heart failure, aged 62 +/- 13 years, were studied. Their election fraction was less than 40% and their serum creatinine was less than 2 mg/dl. Serum uric acid and catecholamines, maximal oxygen consumption (VO2 max) and left ventricular ejection fraction were measured. Mortality and the need for cardiac transplant were recorded as endpoints during a mean follow up of 39 +/- 18 months. The relationship between basal measures and the occurrence of events was analyzed using univariate and multivariate methods. RESULTS: Basal VO2 max and left ventricular ejection fraction were 16 +/- 4.6 ml/kg/min and 22 +/- 7% respectively. Eighteen patients died and three required transplantation during the follow up. Patients reaching these endpoints had a lower VO2 max and left ventricular ejection fraction and higher uric acid levels. Multivariate analysis accepted left ventricular ejection fraction (relative risk 0.89, 95% CI 0.82-0.97) and serum uric acid (relative risk 1.335 95% CI 1.02-1.74) as significant predictors of events. The relative risk for cardiac transplantation was 7.07 times higher among those with a serum uric acid over 7 mg/dl. CONCLUSIONS: A high serum uric acid is an independent predictor of bad prognosis in patients with stable chronic heart failure.

The C677 Mutation in Methylene Tetrahydrofolate Reductase Gene: Correlation with Uric Acid and Cardiovascular Risk Factors in Elderly Korean men

The C677T mutation in the methylene tetrahydrofolate reductase (MTHFR) gene results in elevated homocysteine levels and, presumably, in increased cardiovascular risk. Moreover, elevated homocysteine levels are reportedly associated with high serum uric acid levels. We evaluated the MTHFR genotype and a panel of biochemical, hematological variables, and lifestyle characteristics in 327 elderly Korean men (age range 40-81 yr; mean, 51.87). This study shows that mutation of the MTHFR gene may be a risk for hyperuricemia. The mean uric acid levels for the C/C, C/T and T/T genotypes were 5.54, 5.91 and 6.33 mg/dL, respectively (p=0.000). The T/T genotype was significantly more frequent in subjects with high uric acid levels (p=0.003). Thus, this mutation of the MTHFR gene is implied by the study results to be a risk factor of hyperuricemia in elderly Korean men. However, the relationship between the MTHFR mutation and uric acid metabolism remains unclear. Therefore, further studies are necessary to explain the associated between the MTHFR mutation and elevated uric acid levels, and to examine potential relationships between it and conventional cardiovascular risk factors.