Serum uric acid levels contribute to new renal damage in systemic lupus erythematosus patients

This study aims to determine whether uric acid levels contribute to new renal damage in systemic lupus erythematosus (SLE) patients. This prospective study was conducted in consecutive patients seen since 2012. Patients had a baseline visit and follow-up visits every 6 months. Patients with ≥2 visits were included; those with end-stage renal disease (regardless of dialysis or transplantation) were excluded. Renal damage was ascertained using the SLICC/ACR damage index (SDI). Univariable and multivariable Cox-regression models were performed to determine the risk of new renal damage. Uric acid was included as a continuous and dichotomous (per receiving operating characteristic curve) variable. Multivariable models were adjusted for age at diagnosis, disease duration, socioeconomic status, SLEDAI, SDI, serum creatinine, baseline use of prednisone, antimalarials, and immunosuppressive drugs. One hundred and eighty-six patients were evaluated; their mean (SD) age at diagnosis was 36.8 (13.7) years; nearly all patients were mestizo. Disease duration was 7.7 (6.8) years. Follow-up time was 2.3 (1.1) years. The SLEDAI was 5.2 (4.3) and the SDI 0.8 (1.1). Uric acid levels were 4.5 (1.3) mg/dl. During follow-up, 16 (8.6%) patients developed at least one new point in the renal domain of the SDI. In multivariable analyses, uric acid levels (continuous and dichotomous) at baseline predicted the development of new renal damage (HR 3.21 (1.39–7.42), p 0.006; HR 18.28 (2.80–119.48), p 0.002; respectively). Higher uric acid levels contribute to the development of new renal damage in SLE patients independent of other well-known risk factors for such occurrence.     

心房颤动患者血尿酸水平的研究

目的：比较阵发性心房颤动（房颤）、持续性房颤及无房颤患者的血清尿酸水平。方法：入选102例房颤患者,其中阵发性房颤组患者47例（男性25例）,持续性房颤组患者55例（男性26例）。52例无房颤的患者（男性27例）为对照组。收集患者一般临床资料,检测血常规和生化指标,超声心动图测量左房内径、舒张期左室内径、左室射血分数。以房颤是否发生为因变量,进行多因素logistic回归分析。结果：与对照组比较,阵发性及持续性房颤组的左室射血分数都降低、而C反应蛋白和尿酸水平显著升高（P＜0．05）。多元logistic回归分析显示,高尿酸、高C反应蛋白和左房内径增大是房颤发生的危险因素。结论：房颤患者血清尿酸水平升高,高尿酸是房颤发生的危险因素之一。     

Association of serum uric acid with lupus nephritis in systemic lupus erythematosus

The aim of the present study is to assess the association of elevated serum uric acid (UA) with lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients. A total of 130 SLE patients were recruited, of whom 73 patients developed LN. Blood samples were obtained for determination of uric acid, complement 3 (C3), C-reactive protein (CRP) and some autoantibodies including anti-double-stranded DNA, -Smith, -SSA, -SSB, -U1RNP, SCL-70, and -Jo-1 antibodies. Correlations of UA with LN were assessed. UA was an independent risk factor for LN [odds ratio (95% CI): 1.01 (1.005–1.014); P = 0.0000]. The best cut-off value for UA using the ROC curve was 330 μmol/L (sensitivity 78.1% and specificity 75.4%) and the area under the ROC curve was 0.803 ± 0.039 (95% CI: 0.727–0.878, P = 0.000). Spearman’s correlation coefficient analysis showed negative association of UA with C3 in SLE patients with LN (r = −0.356, P = 0.002), but no association in those without LN. No correlations were found between UA and age, SLEDAI, CRP, IgG, IgM or IgA. Furthermore, analysis of covariance demonstrated that anti-Sm (β = −0.218, P = 0.004) and -U1RNP (β = 0.177, P = 0.008) autoantibodies were independent determinants of serum UA. The UA level is independently associated with the development of LN in SLE patients.     

Serum uric acid is associated with microvascular function in hypertensive individuals

We investigated the relationship of serum uric acid (UA) with resting forearm blood flow (FBF), reactive hyperaemia (RH) and flow-mediated dilation (FMD) of the brachial artery in hypertensive adults (n=506, mean age 62 years, 59% women). UA was measured by a colorimetric method. FBF, RH and FMD were measured by brachial artery ultrasound. Regression analyses were used to assess whether UA was associated with FBF, RH and FMD before and after adjustment for age, sex, systolic BP, diabetes, total and high-density lipoprotein cholesterol, smoking, body mass index (BMI), C-reactive protein (CRP), serum creatinine, alcohol intake, statin and diuretic use and brachial artery diameter (BAD). UA was significantly associated with FBF (P<0.0001) and RH (P=0.0001) but not with FMD (P=0.43). After adjustment for the covariates listed above, higher UA level remained independently associated with a higher FBF (P=0.012) and lower RH (P=0.004). The independent predictors were as follows: (a) higher FBF: lower age, higher BMI, history of smoking, statin use, higher CRP, higher BAD and higher UA levels; (b) lower RH: higher BMI, diabetes and higher UA levels; (c) lower FMD: greater age, male sex, higher BMI, history of smoking, statin use and higher BAD. We conclude that in hypertensive individuals, higher UA levels are associated with higher resting FBF and lower RH, markers of microvascular function, but not with brachial artery FMD.     

Elevated serum uric acid levels are associated with diastolic dysfunction in patients with dilated cardiomyopathy

Objective To assess whether serum uric acid, which is a marker of impaired oxidative metabolism, might correlate with left ventricular systolic and diastolic dysfunction in patients with chronic heart failure (CHF). Background Uric acid levels, which are frequently elevated in patients with CHF, correlate with leg vascular resistance. The effects of elevated levels of uric acid on cardiac function in patients with CHF have never been evaluated. Methods We studied 150 outpatients with CHF who came to our heart failure clinic. Patients underwent a complete echo-Doppler examination, with measurement of mitral E wave and mitral A wave velocities, E/A ratio, E wave deceleration time (DtE), left ventricular volumes, ejection fraction, and stroke volume. A restrictive mitral filling pattern (RMFP) was defined as either E/A ratio >2 or E/A >1 and DtE <140 milliseconds. Results Mean age was 62.2 ± 7.8 years (86% male); 24 patients (16%) had an RMFP. Patients with an RMFP had significantly higher uric acid levels compared with patients without RMFP (0.48 ± 0.14 mmol/L vs 0.38 ± 0.08 mmol/L, respectively, P < .001). Uric acid levels correlated significantly with mitral E wave velocity (r = .22, P < .01), E/A ratio (r = .21, P < .05), DtE (r = .26, P < .01), and RMFP (P = .0001). There was no correlation between uric acid and left ventricular volumes, ejection fraction, or stroke volume. In a multivariate model, uric acid predicted DtE independently of renal function, diuretic dose, and left ventricular volumes. Conclusion Elevated uric acid levels are associated with diastolic dysfunction in CHF. Xanthine oxydase inhibition in patients with CHF might theoretically result in an improvement of diastolic function. (Am Heart J 2002;143:1107-11.)     

Progressive renal failure in patients with lupus nephritis

Abstract. Objective. To investigate the mode of progression to renal failure in patients with lupus nephritis in relation to disease activity and responsiveness to corticosteroid therapy. Design. Retrospective clinical study. Setting. University hospital. Subjects. Twenty-eight patients with progressive lupus nephritis (Cr ≥ 1.4 mg dl^?1). Interventions. Rapidity of progression was defined as the slope of the reciprocal of serum creatinine values. Lupus activity was scored using the systemic lupus erythematosus disease activity index system. Main outcome measures. Improvement of serum creatinine values after 6 months of therapy. Results. Rapidity of progression, which was calculated during the deterioration in kidney function, reflected systemic and serological disease activity, and moreover closely correlated with response to corticosteroid therapy.     

Serum uric acid as a sensitive concordant marker with lupus nephritis and new onset of renal damage: a prospective cohort study

Clinical Rheumatology - The objectives of this study are to assess serum different uric acid levels among systemic lupus erythematosus patients with or without active lupus nephritis in comparison...     

Higher uric acid levels are associated with better functional recovery in elderly patients receiving cardiac rehabilitation

Background and aimsWhether uric acid (UA) serves as risk factor for cardiovascular diseases or as antioxidant defense has not yet been completely clarified. In this study we investigated the effects of UA on functional recovery in patients receiving cardiac rehabilitation.Methods and results306 patients, 209 men and 97 women, age range 25–87 years (mean 68 ± 11), performed the 6-min walk test (6mWT) before and after the rehabilitation, and the increase in walking distance was considered as the outcome measure of the study. Baseline UA serum levels ranged from 1.0 to 10.9 mg/dL (mean 5.2 ± 1.7). As there was a significant (p = 0.005) age*UA levels interaction, patients were divided into two subgroups, less then 65 years (n. 103, 68 men and 35 women, mean age 56 ± 9) and 65 years or more (n. 203, 141 men and 62 women, mean age 74 ± 5). After adjusting for relevant confounders, higher UA levels remained independent positive predictors of the increase in walking distance in older (p < 0.001) but not in younger patients (p = 0.807).ConclusionsOur findings show an independent association of higher UA levels with better functional recovery after cardiac rehabilitation selectively in elderly patients, suggesting that higher UA levels might reflect the decline in antioxidant defenses that occurs with advancing age. Future studies aimed at understanding the several contradictions concerning UA should, probably, address the issue within this perspective.     

Serum uric acid levels in patients with cirrhosis: a reevaluation.

It has been reported that the serum uric acid levels in patients with cirrhosis were decreased compared with healthy subjects. These studies suggested that the lower serum uric acid levels in cirrhotic patients were attributed mainly to an increased effective vascular volume, and consequently to an excessive renal clearance of uric acid. However, the previous observations are challenged by a recent hypothesis for the pathogenesis of hyperdynamic circulation and formation of ascites in cirrhosis. The current study was undertaken to reevaluate serum uric acid levels in patients with cirrhosis. Ninety-eight cirrhotic patients with normal renal functions were included in this study. All biochemical and hemodynamic data were utilized for analysis. The mean serum uric acid level (mean, 6.1+/-1.2 mg/dL; range, 2.7-9.1 mg/dL) was higher than that of the age- and sex-matched healthy control subjects (mean, 5.5+/-1.3 mg/dL; range, 2.9-8.1 mg/dL; p = 0.018). Using multiple regression analysis it was determined that the serum uric acid level was not related to the severity of liver disease, cardiac index, systemic vascular resistance, and hepatic venous pressure gradient but was related closely to age (r = 0.210, p = 0.026) and effective renal plasma flow (r = -0.677, p < 0.0001). Compared with cirrhotic patients without ascites, those with ascites had a significantly higher serum uric acid level (6.7+/-1.6 mg/dL vs. 5.6+/-1.7 mg/dL, p < 0.05) and lower effective renal plasma flow (396+/-125 mL/min vs. 445+/-149 mL/min, p < 0.05). In conclusion, for cirrhotic patients with normal serum creatinine levels, the current study shows that the mean serum uric acid level is higher than that of healthy control subjects. It is not related to the severity of liver failure and systemic and portal hemodynamics, but is related closely to renal functions, especially the renal plasma flow.     

Analysis of risk factors for renal function deterioration in patients with lupus nephritis

<正>Objective To analyze the risk factors for renal function deterioration in patients with lupus nephritis. Methods Clinical data of patients with lupus nephritis admittedto the Third and the First Affiliated Hospital of Zunyi Medical College from June 2013 to June 2015 were reviewed and retrospectively analyzed. Of them,62 lupus nephritis patients with the rapid deterioration of renal function were selected as an observation group,and 62     

Serum interleukin-18 levels in patients with systemic lupus erythematosus: Relation with disease activity and lupus nephritis

Aim of the workTo further investigate the possible role of IL-18 in the pathogenesis of systemic lupus erythematosus (SLE) and development of lupus nephritis (LN), and to explore its relationship with pathological classes of LN, degree of acute renal activity and chronic damage.Patients and methodsForty-one SLE patients with LN, thirty-one lupus non-nephritis patients and fifteen age and sex matched healthy controls were enrolled in this study. SLE patients were subjected to disease activity assessment by SLEDAI, renal disease activity assessment by the Systemic Lupus International Collaborating Clinics (SLICC) Renal Activity Score, laboratory investigations including measurement of serum interleukin-18 using Enzyme Linked Immunosorbent Assay. Renal biopsy was obtained from LN patients and pathological classification was made according to World Health Organization (WHO) criteria. Analysis of activity and chronicity indices was done on these biopsy specimens.ResultsSerum levels of IL-18 were significantly higher in patients with LN than lupus non-nephritis patients and healthy controls (p < 0.001). There were significant correlations between IL-18 and SLEDAI (p = 0.002), proteinuria (p = 0.027), renal activity score (p = 0.003) and activity index (p = 0.039) in patients with LN. There was no significant difference in the serum levels of IL-18 between WHO classes of LN.ConclusionIL-18 appears to have a pathogenic role in the development of SLE and plays a crucial role in triggering inflammation in LN. Serum IL-18 levels could be a useful biomarker to assess the activity of renal disease in SLE.     

Serum free prolactin concentrations in patients with systemic lupus erythematosus are associated with lupus activity

OBJECTIVE: To determine in patients with systemic lupus erythematosus (SLE) the relationships among serum total and free prolactin (PRL) levels, isoforms of PRL and lupus activity. METHODS: In a cross-sectional study, 259 patients with SLE were tested for serum total PRL, serum free PRL, and PRL in fractions obtained after gel filtration chromatography (in 70 sera taken at random) by immunoradiometric assay based on disease activity. RESULTS: A significant correlation between direct PRL and free PRL levels was found in patients with and without lupus activity (r = 0.475, P<0.001); however, this was less so for non-active patients than for active patients (r=0.433, P<0.001 and r=0.909, P<0.001, respectively). SLE Disease Activity Index (SLEDAI) scores correlated positively with serum free PRL levels (r=0.314, P<0.001) and percentage of little PRL (r=0.33, P=0.005) and negatively with percentage of big big PRL (r=-0.3, P=0.012). Patients with active disease had higher serum free PRL levels (median 12.6 vs 9.3 ng/ml, P<0.001), higher percentages of little PRL (83.1 +/- 21.2 vs 63.6 +/- 24.8%, P=0.011) and lower percentages of big big PRL (9.4 +/- 18.0 vs 25.2 +/- 24.3%, P=0.031). Different clinical manifestations and serological parameters of lupus disease activity were more frequent in patients with free hyperprolactinaemia than in patients with normal serum free PRL levels (such as neurological manifestations, renal involvement, serositis, haematological manifestations, anti-double-stranded DNA and hypocomplementaemia; P<0.021). CONCLUSION: An increase in serum free PRL levels, higher percentages of little PRL and lower percentages of big big PRL proved to be factors related to lupus activity in a subset of patients with SLE. These novel data must be taken into account in future studies aiming to establish a relationship between PRL and disease activity in SLE.     

Serum uric acid is independently associated with hypertension in patients with rheumatoid arthritis

Hypertension (HT) is highly prevalent in rheumatoid arthritis (RA). Serum uric acid (SUA) has been associated with HT in the general population. The mutual exclusion of gout and RA, and the systemic inflammatory component of RA may alter this association in this patient population. We explored a potential association between SUA levels and HT in RA and evaluated whether this association is independent of HT risk factors, RA characteristics and relevant drugs. A total of 400 consecutive RA patients were assessed. SUA and complete biochemical profile were measured. Demographic, HT-related factors, RA characteristics and drugs were assessed as potential covariates. Results were analysed using binary logistic models to test the independence of the association between SUA and HT. SUA levels were higher in hypertensive compared to normotensive RA patients (5.44+/-1.6 mg dl(-1) (323.57+/-95.17 micromol l(-1)) vs 4.56+/-1.1 mg dl(-1) (271.23+/-65.43 micromol l(-1)), P<0.001). When adjusted for HT risk factors, renal function, RA characteristics, non-steroidal anti-inflammatory drugs, oral prednisolone, cyclosporine, leflunomide and low-dose aspirin, the odds of being a hypertensive RA patient per 1 mg dl(-1)(59.48 micromol l(-1)) SUA increase were significantly increased: OR=1.59 (95% CI: 1.21-2.1, P=0.001). This was also significant for the subgroup of patients who were not on diuretics (OR=1.5, 95% CI: 1.1-2.05; P=0.011). This cross-sectional study suggests that SUA levels are independently associated with HT in RA patients. Prospective longitudinal studies are needed to confirm and further explore the causes and implications of this association.     

Serum uric acid is associated with microalbuminuria in prehypertension

Serum uric acid is associated with cardiovascular disease. However, the independent role of uric acid in the development of cardiovascular disease is uncertain. This study examined the cross-sectional association of serum uric acid level with microalbuminuria among 6771 subjects without diabetes or hypertension. Blood pressure was categorized as prehypertension (systolic blood pressure, 120 to 140 mm Hg or diastolic blood pressure, 80 to 90 mm Hg) and normotension (systolic blood pressure, <120 mm Hg and diastolic blood pressure, <80 mm Hg). Microalbuminuria was found in 4.0% of normotensive subjects (n=4819) and in 7.9% of prehypertensive subjects (n=1952). Prehypertensive subjects with microalbuminuria had higher uric acid level than those with normoalbuminuria (men, 387 [68] mmol/L versus 371 [69] mmol/L; P=0.017; women 286 [56] mmol/L versus 262 [54] mmol/L; P=0.006). However, the difference in serum uric acid level according to the presence or absence of microalbuminuria was not found in the normotensive group. Multiple logistic regression models showed that, in the prehypertensive group, after adjustment for other cardiovascular risk factors, the highest uric acid quartile entailed >2 times greater risk for microalbuminuria than the lowest quartile in both men (odds ratio, 2.12; 95% CI, 1.16 to 3.87) and women (odds ratio, 3.36; 95% CI, 1.17 to 9.69). In the normotensive group, serum uric acid quartile did not show the independent association with microalbuminuria. In conclusion, serum uric acid level was strongly associated with microalbuminuria in prehypertensive subjects.     

狼疮肾炎终末期肾病患者尸体肾移植的临床观察

目的　探讨狼疮肾炎终末期肾病 (LN ESRD)患者行尸体肾移植手术的可行性及预后和狼疮活动的情况。方法　回顾性分析我院自 1972年开展肾移植手术以来 6例LN ESRD患者在透析时、术前及术后狼疮活动性指数 (SLEDAI)以及移植的时机、移植后免疫抑制剂的使用和人 /肾存活情况。结果　 6例皆为女性患者 ,皆因LN而出现ESRD。移植前皆接受慢性透析治疗 ,其中透析距移植的时间最短为 3个月 ,最长为 9年。移植后 3例用强的松、环孢素A和霉酚酸酯三联免疫抑制治疗 ,另 3例用泼尼松、环孢素A和硫唑嘌呤治疗。 6例患者有 5例存活至今 ,平均存活 (44± 34 )个月 ,最长为 85个月 ,最短为 4个月。 1例在移植后 4个月因高血压脑出血而死亡 ,死前肾功能正常 ,且无狼疮活动。移植术后 1周内移植肾功能皆恢复正常 ,无 1例因狼疮复发而致移植肾功能减退或丧失 ,其中带肾存活最长且肾功能的保持正常者已达 77个月。在慢性透析期间及移植术后无狼疮活动 (SLEDAI<9分 )。结论　肾移植是治疗LN ESRD成功而有效的手段 ,肾移植后狼疮复发率低。     

高脂血症患者血尿酸、瘦素、脂联素水平的变化

目的观察不同临床类型的高脂血症患者血尿酸（uA）、瘦素、脂联素水平,探讨其在高脂血症发病中的作用。方法选择不同临床类型的高脂血症患者336例,分为高胆固醇血症组（高TC组）、高甘油三酯血症组（高TG组）、混合型高脂血症组（混合组）和低高密度脂蛋白血症组（低HDL—C组）组;另选择正常对照组204人。检测各组患者的血尿酸、血清瘦素和脂联素水平,并分析其在脂代谢中的作用。结果与正常对照组相比,高TG组、混合组及低HDL—C组UA水平有不同程度的升高（P〈0．05）,其中高TG组uA水平升高最明显。与正常对照组比较,除低HDL—C组脂联素水平明显升高外（P〈0．05）,其余各高脂血症组无论是血清瘦素水平,还是脂联素水平差异均无统计学意义（P〉0．05）。高脂血症各组之间两两比较,高TG组瘦素水平低于低HDL—C组（P〈0．05）,高TC组脂联素水平低于低HDL—C组（P〈0．05）。结论高脂血症患者存在尿酸代谢紊乱,可能与血清瘦素、脂联素共同参与有关。血清瘦素、脂联素将来有可能成为判定代谢综合征的严重程度及预后的指标。