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Hyperuricemia: pathophysiological aspects, significance in clinical practice

DOI: https://doi.org/10.29296/25877305-2022-02-12
Issue: 
2
Year: 
2022

Professor N. Kunitskaya, MD; Professor A. Aryev, MD; Associate Professor V. Polyakova,
Candidate of Medical Sciences; Professor V. Dobritsa, MD I.I. Mechnikov North-West State Medical University
Russian Ministry of Health, Saint Petersburg

Hyperuricemia, an increase in serum uric acid (UA) concentration above 420 μmol/L for men and 360 μmol/L for women (clinical guidelines of the Russian Association of Rheumatologists (2018)), is a common problem in clinical practice. Existing clinical guidelines regulate the management of patients with symptomatic hyperuricemia, primarily gout, urolithiasis, and acute urate nephropathy, but less attention is given to the primary prevention of these diseases and to the treatment of asymptomatic hyperuricemia. It is also known that UA and, consequently, hyperuricemia are also important in the development of cardiovascular diseases, primarily hypertension, heart failure and chronic kidney disease, and meanwhile, the treatment of asymptomatic hyperuricemia in these patients still depends on the doctor’s opinion. This review analyzed current trends in the treatment of patients with symptomatic and asymptomatic hyperuricemia according to current views on the role of UA in the development of gout, renal, cardiovascular, and other diseases.

Keywords: 
therapy
concomitant pathology
hyperuricemia
uric acid
urate-reducing therapy



References: 
  1. Akbar S.R., Long D.M., Hussain K. et al. Hyperuricemia: an early marker for severity of illness in sepsis. Int J Nephrol. 2015; 2015: 301021. DOI: 10.1155/2015/301021
  2. Álvarez-Lario B., Macarrón-Vicente J. Uric acid and evolution. Rheumatology (Oxford). 2010; 49: 2010–5. DOI: 10.1093/ rheumatology/keq204
  3. Aminiahidashti H., Bozorgi F., Mousavi S.J. et al. Serum uric acid level in relation to severity of the disease and mortality of critically Ill patients. J Lab Physicians. 2017; 9: 42–6. DOI: 10.4103/0974-2727.187916
  4. Bardin T., Keenan R.T., Khanna P.P. et al. Lesinurad in combination with allopurinol: a randomised, double-blind, placebo-controlled study in patients with gout with inadequate response to standard of care (the multinational CLEAR 2 study). Ann Rheum Dis. 2017; 76: 811–20. DOI: 10.1136/annrheumdis2016-209213
  5. Benn C.L., Dua P., Gurrell R. et al. Physiology of hyperuricemia and urate-lowering treatments. Front Med (Lausanne). 2018; 5: 160. DOI: 10.3389/fmed.2018.00160
  6. Borghi C., Tykarski A., Widecka K. et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiol J. 2018; 25: 545–64. DOI: 10.5603/CJ.2018.0116
  7. Chen C., Lü J.-M., Yao Q. Hyperuricemia-related diseases and xanthine oxidoreductase (XOR) inhibitors : an overview. Med Sci Monit. 2016; 22: 2501–12. DOI: 10.12659/msm.899852
  8. Chen-Xu M., Yokose C., Rai S.K. et al. Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: The National Health and Nutrition Examination Survey, 2007–2016. Arthritis Rheumatol. 2019; 71: 991–9. DOI: 10.1002/art.40807
  9. Coiffier B., Altman A., Pui C.H. et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008; 26: 2767–78. DOI: 10.1200/ JCO.2007.15.0177
  10. Dalbeth N., Jones G., Terkeltaub R. et al. Lesinurad, a selective uric acid reabsorption inhibitor, in combination with febuxostat in patients with tophaceous gout: findings of a phase III clinical trial. Arthritis Rheumatol. 2017; 69: 1903–13. DOI: 10.1002/art.40159
  11. Desideri G., Castaldo G., Lombardi A. et al. Is it time to revise the normal range of serum uric acid levels? Eur Rev Med Pharmacol Sci. 2014; 18: 1295–306.
  12. De Cosmo S., Viazzi F., Pacilli A. et al. Serum uric acid and risk of ckd in type 2 diabetes. Clin J Am Soc Nephrol. 2015; 10: 1921–9. DOI: 10.2215/CJN.03140315
  13. Dubreuil M., Zhu Y., Zhang Y. et al. Allopurinol initiation and all-cause mortality in the general population. Ann Rheum Dis. 2015; 74: 1368–72. DOI: 10.1136/annrheumdis-2014-205269
  14. FitzGerald J.D., Dalbeth N., Mikuls T. et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020; 72: 744–60. DOI: 10.1002/ acr.24180
  15. Giordano C., Karasik O., King-Morris K. et al. Uric acid as a marker of kidney disease: Review of the Current Literature. Dis Markers. 2015; 2015: 382918. DOI: 10.1155/2015/382918
  16. Joo H.J., Jeong H.S., Kook H. et al. Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis. BMC Cardiovasc Disord. 2018; 18: 114. DOI: 10.1186/s12872-018-0840-2
  17. Kratzer J.T., Lanaspa M.A., Murphy M.N. et al. Evolutionary history and metabolic insights of ancient mammalian uricases. Proc Natl Acad Sci. 2014; 111: 3763–8. DOI: 10.1073/pnas.1320393111
  18. Khanna D., Fitzgerald J.D., Khanna P.P. et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012; 64: 1431–46. DOI: 10.1002/acr.21772
  19. Kleber M.E., Delgado G., Grammer T.B. et al. Uric acid and cardiovascular events: a mendelian randomization study. J Am Soc Nephrol. 2015; 26: 2831–8. DOI: 10.1681/ASN.2014070660
  20. Kuriyama S., Maruyama Y., Nishio S. et al. Serum uric acid and the incidence of CKD and hypertension. Clin Exp Nephrol. 2015; 19: 1127–34. DOI: 10.1007/s10157-015-1120-4
  21. Mirrakhimov A.E., Voore P., Khan M. et al. Tumor lysis syndrome: a clinical review. World J Crit Care Med. 2015; 4: 130–8. DOI: 10.5492/wjccm.v4.i2.130
  22. Middeke J.M., Schetelig J., Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther. 2017; 10: 597–605. DOI: 10.2147/OTT.S103864
  23. Nodera M., Suzuki H., Matsumoto Y. et al. Association between serum uric acid level and ventricular tachyarrhythmia in heart failure patients with implantable cardioverter-defibrillator. Cardiology. 2018; 140 (1): 47–51. DOI: 10.1159/000488851
  24. Perez-Ruiz F., Dalbeth N., Bardin T. A review of uric acid, crystal deposition disease, and gout. Adv Ther. 2015; 32: 31–41. DOI: 10.1007/s12325-014-0175-z
  25. Ponikowski P., Voors A.A., Anker S.D. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37 (27): 2129–200. DOI: 10.1093/eurheartj/ehw128
  26. Pizarro M.H., Santos D.C., Barros B.S.V. et al. Serum uric acid and renal function in patients with type 1 diabetes: a nationwide study in Brazil. Diabetol Metab Syndr. 2018; 10: 22. DOI: 10.1186/s13098-018-0324-7
  27. Richette P., Doherty M., Pascual E. et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017; 76: 29–42. DOI: 10.1136/annrheumdis-2016-209707
  28. Saag K.G., Becker M.A., Whelton A. et al. Efficacy and safety of febuxostat extended and immediate release in patients with gout and renal impairment: phase III placebo-controlled study. Arthritis Rheumatol. 2019; 71: 143–53. DOI: 10.1002/art.40685
  29. Sautin Y.Y., Johnson R.J. Uric acid: the oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids. 2008; 27 (6): 608–19. DOI: 10.1080/15257770802138558
  30. Shin H.S., Lee H.R., Lee D.C. et al. Uric acid as a prognostic factor for survival time: a prospective cohort study of terminally ill cancer patients. J Pain Symptom Manage. 2006; 31: 493–501. DOI: 10.1016/j.jpainsymman.2005.11.014
  31. Sivera F., Andrés M., Carmona L. et al. Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative. Ann Rheum Dis. 2014; 73: 328–35. DOI: 10.1136/ annrheumdis-2013-203325
  32. Song Y., Tang L., Han J. et al. Uric acid provides protective role in red blood cells by antioxidant defense: a hypothetical analysis. Oxid Med Cell Longev. 2019; 2019: 3435174. DOI: 10.1155/2019/3435174
  33. Xia X., Luo Q., Li B. et al. Serum uric acid and mortality in chronic kidney disease: a systematic review and meta-analysis. Metabolism. 2016; 65: 1326–41. DOI: 10.1016/j.metabol.2016. 05.009
  34. Zhang X., Liu L., Liang R. et al. Hyperuricemia is a biomarker of early mortality in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015; 10: 2519–23. DOI: 10.2147/COPD.S87202