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| LETTER TO EDITOR |
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| Year : 2015 | Volume
: 6
| Issue : 1 | Page : 10 |
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Comment on: Prevention of renal damage by treating hyperuricemia
Hamid Nasri1, Mohammad-Reza Ardalan2, Mahmoud Rafieian-Kopaei3
1 Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Medical Plants Research Center, Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Medical Plants Research Center, Shahrekord University of Medical Sciences, Sharhekord, Iran
| Date of Submission | 08-Mar-2014 |
| Date of Acceptance | 07-Aug-2014 |
| Date of Web Publication | 20-Feb-2015 |
Correspondence Address:
Mahmoud Rafieian-Kopaei
Medical Plants Research Center, Shahrekord University of Medical Sciences, Sharhekord
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2008-7802.151815
How to cite this article:
Nasri H, Ardalan MR, Rafieian-Kopaei M. Comment on: Prevention of renal damage by treating hyperuricemia. Int J Prev Med 2015;6:10 |
DEAR EDITOR,
A recently published article by Nickavar, entitled "prevention of renal damage by treating hyperuricemia in the esteemed "International Journal of Preventive Medicine" was read with great interest. She presented the child with proteinuria, hypertension, and glomerular sclerosis secondary to hypouricosuric hyperuricemia, who was treated by uric acid lowering management. They observed the decrement of proteinuria significantly by uric acid lowering agents. [1] At this paper, I would like to remember a few points. Recently, much attention had been paid toward the impact of hyperuricemia on kidney injury. [2],[3] In addition to various well-known risk factors such as hypertension and diabetes, several "non-traditional" risk factors may contribute to the higher risk of renal injury compared to the general population. [4],[5],[6],[7],[8] In a study on 60 patients with type II diabetes without a history of gout, we detected a significant positive association between body mass index and serum uric acid levels (r = 0.428, P = 0.001). After adjustment for weight, a significant positive association of serum uric acid with level of proteinuria was seen (r = 0.47, P < 0.001) too, [9] moreover, the association of serum uric acid with level of blood pressure was significantly positive. [10] Accordingly, Jalalzadeh et al., conducted a single-blind, randomized cross-over clinical investigation consisting 55 hemodialysis patients with serum uric acid level >6.5 (men) and >5.5 mg/dL (women). [11] They detected the a reduction of blood pressure by allopurinol treatment in hemodialysis patients. [11] Thus, likewise to the beneficial effect of Allopurinal in study of Nickavar, this study also revealed that allopurinol therapy may act as a new potential therapeutic approach to control of blood pressure in patients on hemodialysis. [12],[13],[14] Interestingly it was shown that treatment of hyperuricemia increases 1,25(OH) 2 D levels, proposing that hyperuricemia may have a suppressive effect on 1-α hydroxylase activity. [15] It is possible that high plasma uric acid levels reduce 1,25(OH) 2 D levels by suppressing 1-α hydroxylase and, while low 1,25(OH) 2 D levels can stimulate parathyroid hormone (PTH) that high uric acid levels should be associated with elevated PTH levels too. [2],[15],[16],[17],[18],[19],[20],[21] In accord with this hypothesis, Chen et al., in in vivo study on Sprague Dawley rats, found uric acid suppresses 1-α hydroxylase in vitro and in vivo. [15] In fact, a reduction in 1,25(OH) 2 D secondary to reduced 1-α hydroxylase enzyme activity contributes to the development of secondary hyperparathyroidism in patients with chronic kidney disease. [2],[15],[16],[17],[18],[19],[20],[21] Indeed, the direct association of hyperuricemia and Vitamin D metabolism has two consequences. First, it is well understand that hyperuricemia by itself is an independent risk factor for kidney damage in various nephropathies like IgA nephropathy or diabetic kidney disease. [2],[16],[17],[18],[19],[20],[21],[22],[23],[24] Many studies, support the hypothesis that elevated uric acid levels might have an injurious effect, resulting to inflammation, endothelial dysfunction, and vascular disease. [2],[9],[11],[15],[16],[17] Second, except the deleterious effect of hyperuricemia on hypertension and aggravation of some type of nephropathies, its harmful effect of Vitamin D production is of significant importance. [15],[16],[17],[18],[19],[20],[21],[22],[23] Many studies had shown, support Vitamin D as a negative regulator of the circulating and local tissue renin-angiotensin system (RAS), since RAS has a critical implication in the physiology of sodium and volume homeostasis, hence, excess activity of RAS is associated with high blood pressure, kidney disease, and diabetes. [15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31] Thus, the cast presented by Nickavar, further supports the implication of hyperuricemia in the aggravation of kidney damage.
| References | |  |
| 1. | Nickavar A. Prevention of renal damage by treating hyperuricemia. Int J Prev Med 2013;4:1318-20.  [ PUBMED]  |
| 2. | Nasri H, Rafieian-Kopaei M. Hyperuricemia; a new look at an old problem. J Nephropharmacol 2012;1:13-4. |
| 3. | Amiri M, Nasri H. Secondary hyperparathyroidism in chronic kidney disease patients; current knowledge. J Parathyr Dis 2014;2:1-2. |
| 4. | Kari J. Epidemiology of chronic kidney disease in children. J Nephropathol 2012;1:162-3. |
| 5. | Rastegari E, Nasri H. Association of serum leptin with serum C-reactive protein in hemodialysis patients. J Nephropharmacol 2012;1:19-21. |
| 6. | Assadi F. The epidemic of pediatric chronic kidney disease: The danger of skepticism. J Nephropathol 2012;1:61-4. |
| 7. | Hajivandi A, Amiri M. World Kidney Day 2014: Kidney disease and elderly. J Parathyr Dis 2014;2:3-4. |
| 8. | Namjoo AR, MirVakili M, Shirzad H, Faghani M. Biochemical, liver and renal toxicities of Melissa officinals hydroalcoholic extract on balb/C mice. J Herb Med Pharmacol 2013;2:35-40. |
| 9. | Behradmanesh S, Horestani MK, Baradaran A, Nasri H. Association of serum uric acid with proteinuria in type 2 diabetic patients. J Res Med Sci 2013;18:44-6. [ PUBMED] |
| 10. | Rafieian-Kopaei M, Behradmanesh S, Kheiri S, Nasri H. Association of serum uric acid with level of blood pressure in type 2 diabetic patients. Iran J Kidney Dis 2014;8:152-4. |
| 11. | Jalalzadeh M, Nurcheshmeh Z, Mohammadi R, Mousavinasab N, Ghadiani MH. The effect of allopurinol on lowering blood pressure in hemodialysis patients with hyperuricemia. J Res Med Sci 2012;17:1039-46. [ PUBMED] |
| 12. | Nasri H, Ardalan MR. Significance of hyperuricemia in immunoglobulin a nephropathy. J Renal Inj Prev 2013;2:105-6. |
| 13. | Baradaran A. Primary hyperparathyroidism and kidney; recent findings. J Parathyr Dis 2014;2:5-6. |
| 14. | Nasri H. Correlation of serum magnesium with serum levels of 25-hydroxyvitamin D in hemodialysis patients. J Parathyr Dis 2014;2:11-3. |
| 15. | Chen W, Roncal-Jimenez C, Lanaspa M, Gerard S, Chonchol M, Johnson RJ, et al. Uric acid suppresses 1 alpha hydroxylase in vitro and in vivo. Metabolism 2014;63:150-60. |
| 16. | Baradaran A. Primary hyperparathyroidism and kidney; recent findings. J Parathyr Dis 2014;2:5-6. |
| 17. | Tang Z, Cheng LT, Li HY, Wang T. Serum uric acid and endothelial dysfunction in continuous ambulatory peritoneal dialysis patients. Am J Nephrol 2009;29:368-73. |
| 18. | Nasri H. Commentary on: Is uric acid an indicator of metabolic syndrome in the first-degree relatives of patients with type 2 diabetes? J Res Med Sci 2013;18:267-8. [ PUBMED] |
| 19. | Kuo CF, Luo SF, See LC, Ko YS, Chen YM, Hwang JS, et al. Hyperuricaemia and accelerated reduction in renal function. Scand J Rheumatol 2011;40:116-21. |
| 20. | Nasri H. Elevated serum parathyroid hormone is a heart risk factor in hemodialysis patients. J Parathyr Dis 2013;1:13-4. |
| 21. | Pickering JW, Endre ZH. The definition and detection of acute kidney injury. J Renal Inj Prev 2014;3:21-5. |
| 22. | Juraschek SP, Tunstall-Pedoe H, Woodward M. Serum uric acid and the risk of mortality during 23 years follow-up in the Scottish Heart Health Extended Cohort Study. Atherosclerosis 2014;233:623-9. |
| 23. | Spasovski D. Renal markers for assessment of renal tubular and glomerular dysfunction. J Nephropharmacol 2013;2:23-5. |
| 24. | Nasri H. The awareness of chronic kidney disease and aging; the focus of world kidney day in 2014. J Nephropharmacol 2014;3:1-2. |
| 25. | Nasri H. Impact of diabetes mellitus on parathyroid hormone in hemodialysis patients. J Parathyr Dis 2013;2:9-11. |
| 26. | Rafieian-Kopaei M, Nasri H. Vitamin D therapy in diabetic kidney disease. J Nephropharmacol 2014;3:3-4. |
| 27. | Behradmanesh S, Nasri H. Association of serum calcium with level of blood pressure in type 2 diabetic patients. J Nephropathol 2013;2:254-7. |
| 28. | Ouppatham S, Bancha S, Choovichian P. The relationship of hyperuricemia and blood pressure in the Thai army population. J Postgrad Med 2008;54:259-62. [ PUBMED] |
| 29. | Nasri H, Rafieian-Kopaei M. Association of serum vitamin D level with age in individuals with normal renal function. J Nephropharmacol 2012;1:7-9. |
| 30. | Nasri H, Rafieian-Kopaei M. Significant difference of serum 25-hydroxyvitamin D level in male hemodialysis patients with our without diabetes; a single center study. J Nephropharmacol 2012;1:3-4. |
| 31. | Baradaran A. Beyond mineral metabolism, the bright immunomodulatory effect of vitamin D in renal disease. J Nephropharmacol 2012;1:17-8. |
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