Effect of hyperuricemia on the clinicopathological features and progression of IgA nephropathy / 中国实用内科杂志

ABSTRACT

OBJECTIVE: To investigate the clinical and pathological features in hyperuricemic IgA nephropathy,and the effect of hyperuricemia on progression of IgAN.METHODS: Patients with IgAN confirmed by renal biopsy were enrolled.Those patients were admitted to the First Affiliated Hospital of Fujian Medical University from January 2006 to December 2016.The relationship between uric acid and clinical and pathological changes was analyzed.Patients were followed up and the level of serum creatinine was measured.Primary endpoint was double of creatinine or end-stage renal disease(ESRD)or renal replacement therapy.Risk factors of progression in IgAN were assessed using Kaplan-Meier and Cox proportional hazards analyses.RESULTS: A total of 231 patients with IgAN either reached the endpoint or followed up for more than 2 years were enrolled.Among these patients,the prevalence of hyperuricaemia was 39.8%.There were significant differences in gender,systolic blood pressure,diastolic blood pressure,serum creatinine,blood urea nitrogen,24-hour urine protein,eGFR,degree of tubule atrophy/interstitial fibrosis between high(H-UA)group and normal(N-UA)uric acid group(P<0.05).A total of29 patients reached the endpoint.Univariate COX regression analysis showed that there were significant differences between the progressive group and the non-progressive group in glomerulosclerosis,renal tubular atrophy/interstitial fibrosis,24-hour urine protein quantification,hyperuricemia,anemia,hypertension,blood creatinine,and blood urea nitrogen(P<0.05).Kaplan-Meier survival curve suggested that renal survival was lower in H-UA IgAN group.Anemia,24-hour urine protein,glomerulosclerosis,and serum creatinine are independent risk factors for progression of Ig AN assessed by multivariate analysis.CONCLUSION: Hyperuricemia may be positively associated with severe clinical and pathological damage,more renal tubular atrophy/interstitial fibrosis lesions,and lower renal survival.