RESUMEN
Aim of our study was to ascertain, prospectively, whether serum uric acid is a suitable predictor of preeclampsia and/or the delivery of small-for-gestational-age infants in women with gestational hypertension. We screened 206 primiparas, with a singleton pregnancy, referred for recent onset of hypertension. At presentation, we measured serum uric acid, creatinine, blood glucose, hemoglobin and platelet level, and 24-hour proteinuria, as well as office and 24-hour blood pressures. We followed the women until 1 month after delivery and recorded pregnancy outcome. After logistic regression analysis, uric acid resulted a significant predictor of preeclampsia, with an unadjusted odds ratio of 9.1 (95% CI: 4.8 to 17.4; P<0.001); after adjustment for age, gestation week, hemoglobin and platelet levels, serum creatinine, office and 24-hour average systolic and diastolic blood pressures, it was 7.1 (95% CI: 3.2 to 15.7; P<0.001). Regarding the association between maternal serum uric acid and the chance of giving birth to a small-for-gestational-age infant, the unadjusted odds ratio was 1.7 (95% CI: 1.4 to 2.2; P<0.001), and it was 1.6 (95% CI: 1.1 to 2.4; P=0.02) after adjustment. Receiver operating characteristic analysis showed that serum uric acid, at a 309-µmol/L cutoff, predicted the development of preeclampsia (area under the curve: 0.955), with 87.7% sensitivity and 93.3% specificity, and the delivery of small-for-gestational-age infants (area under the curve: 0.784) with 83.7% sensitivity and 71.7% specificity. In conclusion, the results of our study show that serum uric acid is a reliable predictor of preeclampsia in women referred for gestational hypertension.
Asunto(s)
Edad Gestacional , Hipertensión Inducida en el Embarazo/sangre , Recién Nacido de Bajo Peso , Preeclampsia/epidemiología , Resultado del Embarazo/epidemiología , Ácido Úrico/sangre , Adulto , Biomarcadores/sangre , Presión Sanguínea/fisiología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
An association between high levels of serum uric acid and cardiovascular as well as renal disease has been proposed for many decades. However, only recently compelling basic science data, small clinical trials, and epidemiological studies have provided support to the idea of a true causal effect. In this noncomprehensive review, we present recently published data that evaluate the association between hyperuricemia and selected cardiovascular and renal diseases, with a final conclusion about the possibility of this association being causal.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedades Renales/etiología , Ácido Úrico/sangre , Enfermedades Cardiovasculares/mortalidad , Enfermedad Crónica , Humanos , Factores de RiesgoRESUMEN
BACKGROUND: Despite recent evidence, the role of uric acid as a causal factor in the pathogenesis and progression of kidney disease remains controversial, partly because of the inclusion in epidemiologic studies of patients with hypertension, diabetes, and/or proteinuria. STUDY DESIGN: Prospective observational cohort. SETTING & PARTICIPANTS: 900 healthy normotensive adult blood donors (153 women, 747 men) evaluated at baseline and after 5 years. PREDICTOR: Serum uric acid level. OUTCOMES: Decrease in estimated glomerular filtration rate (eGFR) >10 mL/min/1.73 m(2), computed using the Modification of Diet in Renal Disease (MDRD) Study equation, with secondary analyses examining similar decreases using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockcroft-Gault equations. RESULTS: During a median follow-up of 59 months, eGFR decreased from 97 +/- 16 to 88 +/- 14 mL/min/1.73 m(2). Higher serum uric acid levels were associated with a greater likelihood of eGFR decrease in both women and men (HR, 1.13 [95% CI, 1.04-1.39] per each 1-mg/dL increase in uric acid level); in multivariable analyses adjusting for age, sex, body mass index, blood glucose level, total cholesterol level, mean blood pressure, urine albumin-creatinine ratio, and serum triglyceride level, the association remained highly significant (HR, 1.28 [95% CI, 1.12-1.48]). Results were similar using different estimating equations and when the association was examined in sex-specific subgroups. LIMITATIONS: Analyses were based on a single baseline uric acid measurement. Women are underrepresented. CONCLUSIONS: In healthy normotensive individuals, serum uric acid level is an independent risk factor for decreased kidney function.
Asunto(s)
Riñón/fisiología , Insuficiencia Renal Crónica/sangre , Ácido Úrico/sangre , Adulto , Anciano , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Insuficiencia Renal Crónica/fisiopatología , Factores de RiesgoRESUMEN
BACKGROUND: Microalbuminuria has been linked to cardiovascular (CV) risk in patients with diabetes or hypertension, and in an unselected general population; serum uric acid (UA) is emerging as a novel risk factor for CV disease. The aim of our study was to evaluate the prevalence of excess microalbuminuria and its relation to established CV risk factors and serum UA in healthy subjects. METHODS: We screened 900 healthy blood donors (age range, 20-65 years; 747 men, 153 women), and measured total, HDL and LDL cholesterol, blood glucose, serum and urinary creatinine, serum UA, blood pressure (BP) and microalbuminuria (urinary albumin/creatinine ratio, ACR). The Framingham risk score was also calculated. RESULTS: After excluding 52 participants, we found that in 848 participants (702 men, 146 women) the overall prevalence of excess ACR, using a 30 mg/g creatinine cutoff, was 9.3% (9.7% of men, 7.5% of women, p=0.16); adopting a gender-dependent cutoff, we found that the overall prevalence was 13.6% (15.1% of men, 6.2% of women, p<0.01). ACR was highly correlated to diastolic (r=0.88, p<0.001) and systolic (r=0.74, p<0.001) BP, and also--though not as strongly--to serum UA (r=0.38, p<0.001). In a stepwise multiple regression model, systolic and diastolic BP, total cholesterol, serum creatinine and UA were segregated as independent predictors of microalbuminuria (model R=0.91, R square=0.83). Correlation of serum UA to ACR remained significant, albeit attenuated (r=0.09, p=0.02), after adjustment for serum creatinine, total cholesterol, systolic and diastolic BP. CONCLUSIONS: The results of our study show ACR to be abnormal in a significant proportion of seemingly healthy subjects, and serum UA to be an independent predictor of microalbuminuria.