Revised: March 25, 2013
Accepted: April 10, 2013
Published online: May 6, 2013
A role for uric acid in the pathogenesis and progression of renal disease had been proposed almost a century ago, but, too hastily dismissed in the early eighties. A body of evidence, mostly accumulated during the last decade, has led to a reappraisal of the influence of uric acid on hypertension, cardiovascular, and renal disease. The focus of this review will be solely on the relationship between serum uric acid and renal function and disease. We will review experimental evidence derived from animal and human studies, evidence gathered from a number of epidemiological studies, and from the few (up to now) studies of uric-acid-lowering therapy. Some space will be also devoted to the effects of uric acid in special populations, such as diabetics and recipients of kidney allografts. Finally we will briefly discuss the challenges of a trial of uric-acid-lowering treatment, and the recent suggestions on how to conduct such a trial.
Core tip: The evidence presented so far, derived from experimental, epidemiological, and a few, small, intervention studies, points towards a role for uric acid in the progression of chronic kidney disease and deterioration of renal function. However, conclusive proof, such as that coming from a randomized clinical trial, is lacking. Finally we will briefly discuss the challenges of a trial of uric-acid-lowering treatment, and the recent suggestions on how to conduct such a trial.