高尿酸血症肾病

1、 肾内科肾内科 贾宁贾宁来源来源 排泄排泄80%80%经肾排泄，肾小球滤过及肾小管分泌、重吸收经肾排泄，肾小球滤过及肾小管分泌、重吸收20%20%经胆道和肠道排泄经胆道和肠道排泄外源性：食物中的嘌呤，占体内尿酸外源性：食物中的嘌呤，占体内尿酸20%20%，内源性内源性: : 体内合成或核酸分解，占体内尿酸体内合成或核酸分解，占体内尿酸80%80%American Journal of Kidney Diseases, Vol 52, No 5 (November), 2008: pp 994-1009无症状高尿酸血症合并心血管疾病诊治建议中国专家共识无症状高尿酸血症合并心血管疾病诊治建议中国专

2、家共识 Hypertension. 2003;41:1183-1190 尿酸排泄不良型尿酸排泄不良型 尿酸生成过多型尿酸生成过多型 混合型混合型尿酸排泄尿酸排泄 0.48mgkg-1h-1 0.48mgkg-1h-1 0.51mgkg-1h-1 0.51mgkg-1h-1 0.51mgkg-1h-10.51mgkg-1h-1尿酸清除率尿酸清除率 612ml/min 612 ml/min 612ml/min 612 ml/min 612ml/min 612ml/min # 高尿酸血症高尿酸血症患者低嘌呤饮食患者低嘌呤饮食5 d后后, 留取留取24 h尿检测尿尿酸水平尿检测尿尿酸水平# 尿酸清除率

3、尿酸清除率:(Cua, 尿尿酸尿尿酸每分钟尿量每分钟尿量/血尿酸血尿酸)# 考虑到肾功能对尿酸排泄的影响考虑到肾功能对尿酸排泄的影响, 以肌酐清除率以肌酐清除率(Ccr)校正校正, 根据根据Cua /Ccr 比值对比值对HUA分型如下分型如下: 10%为尿酸生成过多型为尿酸生成过多型; 5%为尿酸排泄不良型为尿酸排泄不良型; 5%10%为混合型为混合型中国医师协会心血管内科医师分会中国医师协会心血管内科医师分会, , 中国医师协会循证医学专业委员会中国医师协会循证医学专业委员会Cleve Clin J Med. 2008 Jul;75 Suppl 5:S13-6 高尿酸增加肾衰竭风险高尿酸增加

4、肾衰竭风险Risk of renal failure in a prospective cohort study of 49,413 Japanese men stratified into quartiles by serum urate level. Risk was calculated relative to the quartile with “moderate” serum urate levels.5Cumulative incidence of ESRD according to baseline serum uric acid level in men and women.

5、The study period was from 1993 to 2000. To convert serumuric acid in mg/dL tomol/L, multiply by 59.48.Am J Kidney Dis, 2004, 44: 642 - 650.基线血尿酸水平越高，基线血尿酸水平越高，ESRD发生率越高发生率越高 Gout and the risk of acute myocardial infarction. Arthritis Rheum 2006; 54:26882696 Krishnan E, Baker JF, Furst DE, Schumacher

6、 HR Jr. Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PIUMA study. Hypertension 2000; 36:10721078 Verdecchia P, Schillaci G, Reboldi G, Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam Study. Stroke 2006; 37:15031507 Bos MJ , Koudstaal PJ . Serum Uric Acid and Cardiovascular Events in Successfully Treated Hypertensive Patients. Hypertension. 1999;34:144-150 Michael H. Alderman; Hillel Cohen; 中国医师协会心血