高尿酸血癥腎病

1、 腎內(nèi)科腎內(nèi)科 賈寧賈寧來(lái)源來(lái)源 排泄排泄80%80%經(jīng)腎排泄，腎小球?yàn)V過及腎小管分泌、重吸收經(jīng)腎排泄，腎小球?yàn)V過及腎小管分泌、重吸收20%20%經(jīng)膽道和腸道排泄經(jīng)膽道和腸道排泄外源性：食物中的嘌呤，占體內(nèi)尿酸外源性：食物中的嘌呤，占體內(nèi)尿酸20%20%，內(nèi)源性內(nèi)源性: : 體內(nèi)合成或核酸分解，占體內(nèi)尿酸體內(nèi)合成或核酸分解，占體內(nèi)尿酸80%80%American Journal of Kidney Diseases, Vol 52, No 5 (November), 2008: pp 994-1009無(wú)癥狀高尿酸血癥合并心血管疾病診治建議中國(guó)專家共識(shí)無(wú)癥狀高尿酸血癥合并心血管疾病診治建議中國(guó)專

2、家共識(shí) Hypertension. 2003;41:1183-1190 尿酸排泄不良型尿酸排泄不良型 尿酸生成過多型尿酸生成過多型 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 # 高尿酸血癥高尿酸血癥患者低嘌呤飲食患者低嘌呤飲食5 d后后, 留取留取24 h尿檢測(cè)尿尿酸水平尿檢測(cè)尿尿酸水平# 尿酸清除率

3、尿酸清除率:(Cua, 尿尿酸尿尿酸每分鐘尿量每分鐘尿量/血尿酸血尿酸)# 考慮到腎功能對(duì)尿酸排泄的影響考慮到腎功能對(duì)尿酸排泄的影響, 以肌酐清除率以肌酐清除率(Ccr)校正校正, 根據(jù)根據(jù)Cua /Ccr 比值對(duì)比值對(duì)HUA分型如下分型如下: 10%為尿酸生成過多型為尿酸生成過多型; 5%為尿酸排泄不良型為尿酸排泄不良型; 5%10%為混合型為混合型中國(guó)醫(yī)師協(xié)會(huì)心血管內(nèi)科醫(yī)師分會(huì)中國(guó)醫(yī)師協(xié)會(huì)心血管內(nèi)科醫(yī)師分會(huì), , 中國(guó)醫(yī)師協(xié)會(huì)循證醫(yī)學(xué)專業(yè)委員會(huì)中國(guó)醫(yī)師協(xié)會(huì)循證醫(yī)學(xué)專業(yè)委員會(huì)Cleve Clin J Med. 2008 Jul;75 Suppl 5:S13-6 高尿酸增加腎衰竭風(fēng)險(xiǎn)高尿酸增加

4、腎衰竭風(fēng)險(xiǎn)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.基線血尿酸水平越高，基線血尿酸水平越高，ESRD發(fā)生率越高發(fā)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; 中國(guó)醫(yī)師協(xié)會(huì)心血