(1) Johns Hopkins University School of Medicine, Baltimore, USA
(2) Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, USA
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Uric acid is the end product of purine metabolism in humans, and hyperuricemia was historically thought to cause only gout and urolithiasis. A number of more recent studies have suggested that uric acid may also play a role in hypertension, cardiovascular disease, metabolic syndrome and renal disease. Animal studies demonstrate that elevated uric acid level causes hypertension and endothelial dysfunction, arteriolopathy and chronic kidney disease. Observational studies in human subjects suggest an association of hyperuricemia with incident kidney disease; however, studies investigating the role of uric acid in chronic kidney disease progression have provided varied results. Small randomized-controlled trials investigating the use of uric-acid lowering drugs have provided promising results but larger interventional clinical trials are needed to establish the role of uric acid in these diseases. This review discusses the current understanding of uric acid in the various comorbidities and diseases managed by nephrologists.
Larger interventional clinical trials are needed to establish the role of uric acid in these diseases.