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Influence of urate-lowering therapies on renal handling of uric acid

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Abstract

The purpose of this study is to investigate the effect of urate-lowering therapies (ULTs) on renal uric acid excretion in gout patients. This prospective observational study involved 106 primary gout patients and 51 healthy controls. Gout patients received ULT with either xanthine oxidase inhibitors or the uricosuric agent benzbromarone. Parameters such as 24-h urinary uric acid, creatinine clearance, uric acid clearance, glomerular filtration load of uric acid, fractional excretion of uric acid, excretion of uric acid per volume of glomerular filtration, and urinary uric acid to urinary creatinine ratio were used to evaluate the pre- and post-treatment renal capacity for uric acid clearance in gout patients and were compared with the values in the healthy controls. Compared to healthy controls, gout patients had higher glomerular filtration load of uric acid and lower uric acid clearance, creatinine clearance, and fractional uric acid excretion. After ULT, both the xanthine oxidase inhibitor group and benzbromarone group patients showed reduction in glomerular filtration load of uric acid. Creatinine clearance was significantly improved in the xanthine oxidase inhibitor group. Excretion function was remarkably enhanced in patients who reached the treatment target (serum uric acid <6 mg/dl). Changes in glomerular uric acid filtration load were significantly correlated with changes in serum urate levels. Gout patients have impaired renal uric acid excretion. ULTs reduce renal urate load and enhance the renal capacity of uric acid clearance. Xanthine oxidase inhibitors showed superiority over benzbromarone in improving renal function.

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Abbreviations

GFR:

Glomerular filtration rate

ULT:

Urate-lowering therapy

XOI:

Xanthine oxidase inhibitors

Ccr:

Clearance of creatinine

Cua:

Clearance of uric acid

FEua:

Fractional excretion of uric acid

FLua:

Glomerular filtration load of uric acid

Uua/Ucr:

Urinary uric acid to Urinary creatinine ratio

ACR:

American College of Rheumatology

AKI:

Acute kidney injury

RAS:

Renin-angiotensin system

ARB:

Angiotensin receptor blockers

CKD:

Chronic kidney disease

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Acknowledgments

This research was supported by grant No. 11DJ1400101 (The Pathogenesis and Therapy of Hyperuricemia and Gout) from Shanghai Committee of Science and Technology Major Program.

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Authors and Affiliations

  1. Department of Rheumatology, Zhongshan Hospital, No. 180, Road Fenglin, Shanghai, 200032, People’s Republic of China

    Lili Ma, Lei Wei, Huiyong Chen, Zhuojun Zhang, Qiang Yu, Zongfei Ji & Lindi Jiang

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  1. Lili Ma
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  2. Lei Wei
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Correspondence to Lindi Jiang.

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Lili Ma and Lei Wei contributed equally to this work

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Ma, L., Wei, L., Chen, H. et al. Influence of urate-lowering therapies on renal handling of uric acid. Clin Rheumatol 35, 133–141 (2016). https://doi.org/10.1007/s10067-014-2806-9

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  • DOI: https://doi.org/10.1007/s10067-014-2806-9

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