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1.
Med Clin North Am ; 105(2): 297-310, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33589104

RESUMO

Gout is the most common inflammatory arthritis in the United States. Gouty arthritis is associated with significant morbidity and mortality and is caused by hyperuricemia. Gout is effectively managed and potentially cured by decreasing the overall urate burden with serum urate-lowering therapy. When serum urate is maintained at less than 6.0 mg/dL urate deposition is resolved and gout can be cured. Unfortunately, owing to a lack of physician monitoring and dose escalation the majority of patients do not achieve these urate levels.


Assuntos
Artrite Gotosa , Monitoramento de Medicamentos/métodos , Supressores da Gota/farmacologia , Gota , Artrite Gotosa/diagnóstico , Artrite Gotosa/prevenção & controle , Artrite Gotosa/terapia , Gota/sangue , Gota/fisiopatologia , Gota/terapia , Humanos , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia
2.
Public Health ; 190: 135-144, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33451823

RESUMO

OBJECTIVES: Diabetes mellitus is the most common cause of chronic kidney disease (CKD); however, the inter-relationships and pathogenetic mechanisms among risk factors are still largely unknown. Structural equation modelling (SEM) was applied to test a hypothesis of causal pathways related to CKD in patients with type 2 diabetes mellitus (T2DM). STUDY DESIGN: This is a prospective observational study. METHODS: A total of 3395 patients with T2DM were enrolled in this study. A hypothesised SEM was applied to assess associations among demographic data, diabetic self-management behaviours, diabetes control, lifestyle, psycho-social, chronic inflammation factors, anthropometric and metabolic variables simultaneously and the risk of CKD. RESULTS: Demographic data (including education, marital status and mini-mental state examination score) (-0.075), white blood cell count (0.084), high blood pressure (0.144), World Health Organisation (WHO) 5 well-being index (-0.082), diabetes control (0.099), triglyceride (0.091) and uric acid (0.282) levels had direct effects on the risk of CKD. The final model could explain 26% of the variability in baseline CKD status. In addition, the same direct and specific indirect factors at baseline CKD status analysis contributed to the risk of CKD at the 12-month follow-up. The final model could explain 31% of the variability in the risk of CKD at the 12-month follow-up. CONCLUSIONS: This study investigates associations between factors obtained from real-world daily practice and CKD status simultaneously and delineates the potential pathways and inter-relationships of the risk factors that contribute to the development of CKD in patients with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hipertensão/complicações , Hiperuricemia/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Triglicerídeos/sangue , Ácido Úrico/sangue , Adulto , Idoso , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Taxa de Filtração Glomerular , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/etiologia , Fatores de Risco
3.
Medicine (Baltimore) ; 99(31): e21438, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756155

RESUMO

RATIONALE: Mutations in the hepatocyte nuclear factor-1-beta (HNF1B) gene result in a very variable presentation, including maturity onset diabetes of the young (MODY), renal cysts, renal dysplasia, and autosomal dominant tubulointerstitial kidney disease (ADTKD), which is characterized by tubular damage, renal fibrosis, and progressive renal dysfunction. PATIENT CONCERNS: A 22-year-old man came to the hospital presenting with hyperglycemia, hyperuricemia and elevated serum creatinine. His urine protein was within the normal range. The ultrasound examination revealed shrunken kidneys with renal cysts. The patient's mother was diagnosed with diabetes mellitus when she was 25 years old. Her laboratory results showed elevated serum creatinine. Her ultrasonography revealed shrunken kidneys with renal cysts and hydronephrosis without kidney stones. The next-generation sequencing revealed that the proband and his mother held the same heterozygous missense mutation (c.530G>A, NM_000458, p.R177Q) in the HNF1B gene. Bioinformatic analyses predicted that the mutation was likely pathogenic. DIAGNOSIS: The patient and his mother were diagnosed as ADTKD and MODY5 due to HNF1B mutation. INTERVENTION: The proband was administered metformin at a dose of 500 mg/day. OUTCOMES: The patient had well-controlled blood glucose levels and a stable renal function at his 12-month follow-up. LESSONS: We should take into account the diagnoses of ADTKD and MODY5 if patients present with early onset diabetes and multiple renal cysts or evidence of renal tubulointerstitial dysplasia, especially those with negative proteinuria results. Genetic testing helps detect the HNF1B gene mutations.


Assuntos
Doenças do Sistema Nervoso Central/genética , Esmalte Dentário/anormalidades , Diabetes Mellitus Tipo 2/genética , Fator 1-beta Nuclear de Hepatócito/genética , Doenças Renais Císticas/genética , Nefrite Intersticial/genética , Assistência ao Convalescente , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Heterozigoto , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Hiperglicemia/etiologia , Hiperuricemia/etiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Rim/diagnóstico por imagem , Rim/patologia , Rim/fisiopatologia , Doenças Renais Císticas/complicações , Doenças Renais Císticas/tratamento farmacológico , Doenças Renais Císticas/patologia , Masculino , Metformina/administração & dosagem , Metformina/uso terapêutico , Mutação de Sentido Incorreto , Nefrite Intersticial/complicações , Nefrite Intersticial/patologia , Linhagem , Ultrassonografia/métodos , Adulto Jovem
4.
High Blood Press Cardiovasc Prev ; 27(5): 409-415, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32772309

RESUMO

INTRODUCTION: Hyperuricemia is related to health issues among children and adolescents, once the uric acid concentration is associated with metabolic syndrome, hypertension, insulin resistance, obesity, and dyslipidemia. However, few studies are addressing uric acid levels and food uptake in this age group. AIM: To verify the association between food consumption and uric acid in children and adolescents. METHODS: This is a cross-sectional study developed with 2335 children and adolescents of both genders aged 6-17 years old. Blood collection was performed after 12 h of fasting. Uric acid values were classified according to tertiles, in which the highest tertile was considered as hyperuricemia. Food consumption was evaluated by weekly consumption frequency questionnaire. Pearson correlation and logistic binary regressions were used for statistical analysis. Models were adjusted for age, systolic blood pressure, body mass index (BMI), and skin color/ethnicity. RESULTS: It was found an association between red meat consumption and hyperuricemia only in boys in the crude model (OR = 1.56; 95% CI 1.12; 2.18). Also, there was an association between pasta (OR = 1.52; 95% CI 1.11; 2.10) with hyperuricemia in boys, when adjusted age, systolic blood pressure, BMI, and skin color/ethnicity. CONCLUSION: The knowledge of food patterns which are predisposing factors for the increase in serum uric acid levels is important for the implementation of strategies and public health policies for health promotion among children and adolescents.


Assuntos
Dieta/efeitos adversos , Ingestão de Alimentos , Comportamento Alimentar , Hiperuricemia/etiologia , Ácido Úrico/sangue , Adolescente , Fatores Etários , Biomarcadores/sangue , Criança , Estudos Transversais , Feminino , Humanos , Hiperuricemia/sangue , Hiperuricemia/diagnóstico , Masculino , Medição de Risco , Fatores de Risco , Fatores Sexuais , Regulação para Cima
5.
Medicine (Baltimore) ; 99(34): e21847, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846834

RESUMO

RATIONALE: Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder presenting with uric acid overproduction, neurocognitive disability, and behavioral disturbances. Inhalational anesthesia has been frequently used in LNS patients undergoing surgery. Characteristic compulsive self-injurious behavior and high risk of emesis may hinder inhalational induction. Propofol may be beneficial for these patients because of its easy and rapid titration for anesthetic depth during induction, early recovery from anesthesia, and antiemetic effect as well as uricosuric effect. PATIENT CONCERNS: A 16-year-old male adolescent was scheduled for percutaneous nephrolithotomy. He exhibited poorly controlled muscle, self-injurious behaviors and intellectual disability. DIAGNOSIS: The patient presented with neurodevelopmental delay in the first year of life, and was diagnosed with LNS, with a substitution of phenylalanine to leucine in hypoxanthine-guanine phosphoribosyltransferase (HPRT) 1 gene on the X-chromosome at 3 years of age. INTERVENTIONS: Total intravenous anesthesia was used for induction and maintenance of anesthesia with propofol and remifentanil using target-controlled infusion. OUTCOMES: Time to recovery of consciousness was prolonged after uneventful surgery. Serum uric acid levels gradually increased during postoperative period. LESSONS: Propofol anesthesia using target-controlled infusion does not provide significant clinical advantages in rapid emergence from anesthesia and management of hyperuricemia in LNS patients undergoing urological surgery.


Assuntos
Anestesia Geral/efeitos adversos , Hipoxantina Fosforribosiltransferase/genética , Síndrome de Lesch-Nyhan/psicologia , Propofol/administração & dosagem , Administração Intravenosa , Adolescente , Período de Recuperação da Anestesia , Anestesia Geral/métodos , Humanos , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Deficiência Intelectual/etiologia , Cálculos Renais/cirurgia , Síndrome de Lesch-Nyhan/sangue , Síndrome de Lesch-Nyhan/diagnóstico , Síndrome de Lesch-Nyhan/genética , Masculino , Nefrolitotomia Percutânea/métodos , Transtornos do Neurodesenvolvimento/etiologia , Comportamento Autodestrutivo/etiologia , Resultado do Tratamento , Ácido Úrico/sangue , Vômito/induzido quimicamente
6.
Am J Clin Nutr ; 112(3): 652-660, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32644154

RESUMO

BACKGROUND: The elevated consumption of sugar-sweetened beverages (SSBs) in Mexico is an important public health concern. However, the association between SSB consumption and hyperuricemia has been scarcely studied and not well documented. OBJECTIVES: To prospectively evaluate the association between SSB consumption and risk of hyperuricemia in Mexican adults. METHODS: A longitudinal analysis was conducted using data from the Health Workers Cohort Study. Participants were followed from 2004 to 2018, with measurements every 6 y. The analysis sample consisted of 1300 adults, aged 18 to 85 y. SSB consumption during the previous year was evaluated through a semiquantitative FFQ. Hyperuricemia was defined as a concentration of uric acid ≥7.0 mg/dL in men and ≥5.7 mg/dL in women. We evaluated the association of interest using 2 methodologies: fixed-effects logistic regression and generalized estimating equations (GEEs). Potential confounders were included in both approaches. RESULTS: At baseline, median intake of SSBs was 472.1 mL/wk (IQR: 198.8-1416.4 mL/wk), and 233 participants had hyperuricemia. Uric acid was higher in participants with an SSB intake ≥7 servings/wk, compared with those with an intake <1 serving/wk (P < 0.001). Participants who changed from the lowest to the highest category of servings consumption experienced 2.6 increased odds of hyperuricemia (95% CI: 1.27, 5.26). Results from the GEE model indicated the odds of hyperuricemia increased by 44% (OR=1.44; 95% CI: 1.13, 1.84) in the 2-6 servings/wk group, and by 89% (OR=1.89; 95% CI: 1.39, 2.57) in the ≥7 servings/wk categories, compared with the <1 serving/wk category. Diet soft drinks were not associated with hyperuricemia. CONCLUSIONS: Our results suggest that the consumption of SSBs is associated with an increased risk of hyperuricemia in Mexican adults, but diet soft drink consumption is not, which supports the need to strengthen existing recommendations to reduce the intake of SSBs.The Health Workers Cohort Study (HWCS) has been approved by the Institutional Review Board of the Mexican Social Security Institute (12CEI 09 006 14), and the National Institute of Public Health of Mexico (13CEI 17 007 36).


Assuntos
Hiperuricemia/epidemiologia , Hiperuricemia/etiologia , Bebidas Adoçadas com Açúcar/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Pessoal de Saúde , Humanos , Estudos Longitudinais , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Adulto Jovem
7.
Clin Nephrol ; 94(2): 61-69, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32589132

RESUMO

AIM: Febuxostat is initiated in chronic kidney disease (CKD) patients to lower uric acid but without any renal dosing scheme. This study aimed to determine a formula that predicts the effective dose of febuxostat in patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min and asymptomatic hyperuricemia. MATERIALS AND METHODS: This is a retrospective analysis of 100 CKD patients treated with febuxostat for asymptomatic hyperuricemia in two private Lebanese clinics. Patients with gout were excluded. Collected variables were age, sex, weight, serum creatinine, serum uric acid (sUA) before and after febuxostat, dose of febuxostat used, and diuretic use. Multiple regression analysis was used to derive a formula predicting the dose of febuxostat based on eGFR (2009 Chronic Kidney Disease Epidemiology Collaboration equation), baseline sUA, and sUA reduction ratio. A prospective cohort of 24 patients was then used to validate the derived model. RESULTS: 100 patients were included with a median age of 71.5 years (interquartile range (IQR), 64.2 - 79.0); 69% were men. Median baseline sUA was 9.1 mg/dL (IQR, 8.4 - 10.1). Mean eGFR was 31.80 ± 12.96 mL/min/1.73m2. Of the included patients, 18% had CKD stage 3a, 36% had CKD stage 3b, 38% had CKD stage 4, and 8% had non-dialysis CKD stage 5. A formula was computed to predict febuxostat dosing. Variables that were predictive of febuxostat dose and used in the final equation were eGFR, diuretic use, baseline sUA, and sUA reduction ratio. The validation cohort showed no significant difference between the expected sUA and the measured one (p = 0.16). CONCLUSION: With this new formula, physicians can initiate febuxostat in CKD patients at an effective dose for any desired sUA reduction ratio.


Assuntos
Febuxostat/administração & dosagem , Supressores da Gota/administração & dosagem , Hiperuricemia , Insuficiência Renal Crônica , Idoso , Febuxostat/uso terapêutico , Feminino , Supressores da Gota/uso terapêutico , Humanos , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Estudos Retrospectivos , Ácido Úrico/sangue
8.
PLoS One ; 15(6): e0234909, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574194

RESUMO

OBJECTIVES: Although studies have demonstrated the association of hyperuricemia with cardiovascular (CV) diseases, few have explored the effect of urate-lowering therapy (ULT) on the incidence of CV diseases. Therefore, we compared the risks of hospitalized coronary artery disease (CAD), stroke, heart failure (HF), and all-cause mortality between ULT users and nonusers among patients with gout. METHODS: We performed this retrospective cohort study using Taiwan's population-based National Health Insurance Research Database. In total, 5218 patients with gout were included from 2000 to 2012. We compared the incidence rates (IRs) of hospitalized CAD, stroke, HF, and all-cause mortality between ULT users and matched nonusers. RESULTS: The IRs of hospitalized stroke were 0.6 and 1.0 per 100 person-years for ULT users and nonusers, respectively, after adjusting for age, sex, residence, comorbidities, and medications. ULT users showed lower adjusted hazard ratios (aHR) for hospitalized stroke (aHR: 0.52, p < 0.001) and all-cause mortality (aHR: 0.6, p = 0.02) than nonusers. Subgroup analyses revealed that uricosuric agents and xanthine oxidase inhibitors were significantly associated with lower risks of hospitalized stroke and all-cause mortality, respectively. The effect of uricosuric agents on the decrease in hospitalized stroke risk indicated a dose-response relationship. CONCLUSIONS: Our study showed lower risks of hospitalized stroke and all-cause mortality in ULT users than in nonusers among patients with gout. Therefore, patients with gout may receive ULT to mitigate the risks of hospitalized stroke and mortality.


Assuntos
Supressores da Gota/uso terapêutico , Gota/tratamento farmacológico , Hiperuricemia/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Alopurinol/uso terapêutico , Feminino , Gota/sangue , Gota/complicações , Mortalidade Hospitalar , Hospitalização , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Taiwan/epidemiologia , Resultado do Tratamento , Ácido Úrico/antagonistas & inibidores , Ácido Úrico/sangue , Adulto Jovem
9.
Sci Rep ; 10(1): 8616, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32451462

RESUMO

We reported a large Chinese family diagnosed with autosomal dominant tubulointerstitial kidney disease caused by MUC1 mutation (ADTKD-MUC1). Cytosine duplication within a string of 7 cytosines in the variable-number tandem repeats (VNTR) region of the MUC1 gene was detected by long-read single-molecule real-time (SMRT) sequencing. MUC1 frameshift protein (MUC1fs) was found to be expressed in renal tubules and urinary exfoliated cells by pathological examination. The family, which consisted of 5 generations including 137 individuals, was followed for 5 years. Genetic testing was performed in thirty-four individuals, 17 of whom carried MUC1 mutations. The ADTKD-MUC1-affected individuals had an elevated incidence of hyperuricaemia without gout attack. Within five years, higher baseline levels of urinary α1-microglobulin were detected in affected individuals with rapidly progressing renal failure than in affected individuals with stable renal function, and the increases manifested even before increases in serum creatinine. This study demonstrates that SMRT sequencing is an effective method for the identification of MUC1 mutations. The pathological examination of MUC1fs expression in renal tissue and urinary exfoliated cells can contribute to early screening of family members suspected to be affected. It is suggested that affected individuals with elevated urinary α1-microglobulin levels should be closely monitored for renal function.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Mucina-1/genética , Rim Policístico Autossômico Dominante/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , China , Feminino , Mutação da Fase de Leitura , Testes Genéticos , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/etiologia , Rim/diagnóstico por imagem , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Linhagem , Rim Policístico Autossômico Dominante/genética , Rim Policístico Autossômico Dominante/patologia , Sequências de Repetição em Tandem/genética , Ultrassonografia , Ácido Úrico/urina , Sequenciamento Completo do Exoma
10.
Rev Esp Salud Publica ; 942020 Apr 28.
Artigo em Espanhol | MEDLINE | ID: mdl-32382003

RESUMO

OBJECTIVE: There is no clear consensus over the findings of research into shift work and cardiovascular risk factors, such as those present in the metabolic syndrome (MetS). This is further confounded by the varying definitions of MetS and shift work. Our objective was to learn about the link between shift work, lifestyles and cardiovascular health in chemical factory workers. METHODS: Cross-sectional analytical study, carried out 2018-2019; data obtained from annual occupational health check-ups. 515 workers chosen, with a 1:3 ratio (shifts/no shifts). Variables collected: MetS, arterial hypertension, obesity, abdominal adiposity and biochemical alterations (glucose, total cholesterol, HDL cholesterol, triglycerides and uric acid). Explanatory variables: age, gender, tobacco consumption, physical activity and shift work. Besides the usual descriptions, both non-adjusted and adjusted bivariate logistic regression were performed, producing Odds Ratio (OR) values with 95% CI. RESULTS: The non-adjusted logistic regression showed that shift workers performed less physical activity (OR=0.22; 95% CI=0.14-0.35; p<0.001) and had lower HDL cholesterol levels (OR=2.1; 95% CI=1.2-3.8; p<0.05), plus a higher rate of hypertriglyceridemia (OR=2.05; 95% CI=1.3-3.2; p<0.01) and hyperuricemia (OR=2.7; 95% CI=0.9-2.7; p<0.001). In the logistic regression adjusted for age, gender, tobacco consumption, physical activity and shift work only the prevalence of hyperuricemia was higher in shift workers (OR=2.25; 95% CI=1.1-4.6; p<0.05), as well as with less moderate/high physical activity (OR=0.19; 95% CI=0.12-0.31; p<0.001). CONCLUSIONS: While no link was found between shift work and increased smoking or a higher cardiovascular risk, there was evidence of an association with high uric acid levels and less moderate/high physical activity.


Assuntos
Indústria Química , Hiperuricemia/etiologia , Doenças Profissionais/etiologia , Jornada de Trabalho em Turnos/efeitos adversos , Tolerância ao Trabalho Programado , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos Transversais , Feminino , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/epidemiologia , Estilo de Vida , Modelos Logísticos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Razão de Chances , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Espanha/epidemiologia
11.
Transplant Proc ; 52(4): 1147-1151, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32197869

RESUMO

INTRODUCTION: Renal transplantation (RT) has evolved to improve its functionality. Some factors have been little studied, one of which is hyperuricemia and its impact on renal graft function. The objective of this study is to determine the prevalence of complications of renal transplantation and its influence on hyperuricemia values in the first year of evolution. MATERIAL AND METHODS: The authors completed a retrospective, observational study of 2 RT units in Mexico from January 2013 to December 2017. In total, 1009 files met the inclusion criteria; the levels of uric acid (UA) and creatinine (Cr) were determined before transplantation and in months 1, 3, 6, 9, and 12 after transplantation. Descriptive analysis was performed with measures of central tendency, measures of dispersion, difference of means with Student t test, and SPSS version 25 (IBM, Armonk, NY, United States). RESULTS: The mean pretransplant UA was 6.24 mg/dL (standard deviation [SD] 1.97); per month was 4.73 mg/dL (SD 1.49). There is a difference in means between categorized groups of UA in the 5 post-RT moments (1, 3, 6, 9, and 12 months). A positive correlation of 0.41 to 0.47 was found with Spearman's test. The delayed function of the graft influenced in the first month after transplant in presenting hyperuricemia and acute dysfunction in month 6 showed that the rejection had no significance at any time. CONCLUSIONS: The relationship between the values of UA and Cr in the RT represents a moderate positive correlation; delayed graft function in the first month impacts the presence of hyperuricemia, as well as acute dysfunction at month 6 after transplantation.


Assuntos
Função Retardada do Enxerto/epidemiologia , Função Retardada do Enxerto/etiologia , Hiperuricemia/epidemiologia , Hiperuricemia/etiologia , Transplante de Rim/efeitos adversos , Creatinina/sangue , Feminino , Humanos , Masculino , México , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Ácido Úrico/sangue
12.
Medicine (Baltimore) ; 99(12): e19535, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195957

RESUMO

Hyperuricemia has been associated with metabolic syndrome, and the association with various cardiometabolic risk factors may be affected by sex.We made a cross-sectional examination in a military cohort of 6738 men and 766 women, aged 18 to 50 years of Taiwan in 2013 to 2014. Hyperuricemia were defined as serum uric acid levels ≥7.0 mg/dL for men and ≥5.7 mg/dL for women, respectively. Multivariable logistic regression analyses were used to determine the associations between hyperuricemia and various metabolic abnormalities.In the overall population, hyperuricemia was associated with high blood pressure (odds ratio [OR]: 1.59, and 95% confidence intervals: 1.42-1.77), low high-density lipoprotein (OR: 1.75, 1.56-1.97), high triglycerides (OR: 2.14, 1.90-2.42), high low-density lipoprotein (OR: 1.71, 1.51-1.93), high fasting plasma glucose (OR: 1.29, 1.13-1.48), and central obesity (OR: 2.85, 2.55-3.18) after adjusting for age and serum creatinine concentrations. However, the associations with atherogenic lipid profiles including high triglycerides and high low-density lipoprotein were merely significant in men but not in women. In addition, there was a tendency for a sex difference in the association of hyperuricemia and raised blood pressure ≥130/85 mm Hg, which was greater in women than that in men (OR: 2.92, 1.37-6.25 and 1.54, 1.37-1.72, respectively; P for interaction = .059).Our findings suggest that the association between hyperuricemia and various cardiometabolic abnormalities in young adults may differ by sex, possibly due to a regulation of sex hormones and uneven effects of uric acid at the same levels between sexes on lipid metabolisms and arterial stiffness.


Assuntos
Hiperuricemia/etiologia , Síndrome Metabólica/complicações , Militares/estatística & dados numéricos , Rigidez Vascular/fisiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertrigliceridemia/complicações , Hiperuricemia/epidemiologia , Masculino , Síndrome Metabólica/epidemiologia , Obesidade Abdominal/complicações , Fatores de Risco , Caracteres Sexuais , Taiwan/epidemiologia , Ácido Úrico/sangue , Adulto Jovem
13.
Lancet Haematol ; 7(2): e168-e176, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32004486

RESUMO

Tumour lysis syndrome is a complication of chemotherapy for haematological malignancies; in particular, aggressive leukaemias and lymphomas. For haematological malignancies, targeted therapies, such as small molecule inhibitors and monoclonal antibodies, have a high anti-tumour activity, are well tolerated, and have a low incidence of associated tumour lysis syndrome. The BCL-2 inhibitor venetoclax has a high anti-tumour activity in chronic lymphocytic leukaemia, achieving deep remissions by potently inducing apoptosis and increasing the risk for tumour lysis syndrome. In this Viewpoint, we discuss the pathophysiology, risk factors, monitoring, changes in laboratory parameters, and clinical manifestations of tumour lysis syndrome, and the prophylaxis and treatments available for this complication. Prophylaxis and treatment strategies have been implemented as standard of care in patients receiving venetoclax to minimise the risk of both laboratory and clinical manifestations of tumour lysis syndrome.


Assuntos
Antineoplásicos/efeitos adversos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Terapia de Alvo Molecular/efeitos adversos , Proteínas de Neoplasias/antagonistas & inibidores , Inibidores de Proteínas Quinases/efeitos adversos , Proteínas Proto-Oncogênicas c-bcl-2/antagonistas & inibidores , Síndrome de Lise Tumoral/etiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Alopurinol/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/etiologia , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , Sinergismo Farmacológico , Humanos , Hiperfosfatemia/etiologia , Hiperfosfatemia/terapia , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Leucemia Linfocítica Crônica de Células B/enzimologia , Diálise Renal , Fatores de Risco , Índice de Gravidade de Doença , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Síndrome de Lise Tumoral/diagnóstico , Síndrome de Lise Tumoral/tratamento farmacológico , Síndrome de Lise Tumoral/prevenção & controle , Urato Oxidase/uso terapêutico
14.
Medicina (Kaunas) ; 56(3)2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32106421

RESUMO

BACKGROUND: In kidney transplant recipients (KTR), hyperuricemia (HU) is a commonly-observed phenomenon, due to calcineurin inhibitors and reduced kidney graft function. Factors predicting HU, and its association with graft function, remains equivocal. METHODS: We conducted a retrospective longitudinal study to assess factors associated with HU in KTR, and to determine risk factors associated with graft function, measured as glomerular filtration rate (GFR). Moreover, GFR > 60 mL/min/1.73 m2 was considered normal. HU was defined as a serum uric acid level of > 416 µmol/L (4.70 mg/dL) in men and >357 µmol/L (4.04 mg/dL) in women, or xanthine-oxidase inhibitor use. We built multiple logistic regression models to assess predictors of HU in KTR, as well as the association of demographic, clinical, and biochemical parameters of patients with normal GFR after a three-year follow-up. We investigated the effect modification of this association with HU. RESULTS: There were 144 patients (mean age 46.6 ± 13.9), with 42.4% of them having HU. Predictors of HU in KTR were the presence of cystic diseases (OR = 9.68 (3.13; 29.9)), the use of diuretics (OR = 4.23 (1.51; 11.9)), and the male gender (OR = 2.45 (1.07; 5.56)). Being a younger age, of female gender, with a normal BMI, and the absence of diuretic medications increased the possibility of normal GFR. HU was the effect modifier of the association between demographic, clinical, and biochemical factors and a normal GFR. CONCLUSIONS: Factors associated with HU in KTR: Presence of cystic diseases, diuretic use, and male gender. HU was the effect modifier of the association of demographic, clinical, and biochemical factors to GFR.


Assuntos
Hiperuricemia/etiologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Inibidores de Calcineurina/uso terapêutico , Diuréticos/efeitos adversos , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Rim/fisiopatologia , Doenças Renais Císticas/complicações , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Transplantes/fisiopatologia , Ácido Úrico/sangue , Xantina Oxidase/antagonistas & inibidores
15.
Leuk Res ; 89: 106298, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31945598

RESUMO

While rasburicase has shown efficacy to rapidly correct hyperuricemia compared with allopurinol, its overall impact in improving clinically significant outcomes, such as acute kidney injury (AKI), in tumor lysis syndrome (TLS) is unknown. In this retrospective cohort study, we included all hospitalized cancer patients with hyperuricemia and AKI who received rasburicase +/- allopurinol or allopurinol alone from 2009 to 2015. Inverse probability of treatment weighting using propensity score was used to account for potential confounders and to estimate the causal effect associated with differential drug treatment. 150 patients met inclusion criteria; 89 received rasburicase +/- allopurinol and 61 received allopurinol alone. Weighted outcome regression analysis demonstrated that rasburicase was associated with significantly lower mean uric acid nadir at 7 days compared to allopurinol (2.70 versus 5.82 mg/dL, p < 0.01). However, likelihood of renal function recovery (OR = 0.90, p = 0.79), creatinine nadir by 7 days (1.80 versus 1.66 mg/dL, p = 0.51), and final creatinine by 30 days (2.08 versus 2.07 mg/dL, p = 0.98) did not significantly differ. In conclusion, the clinical benefit of rasburicase in promoting renal function recovery in cancer patietns with concurrent hyperuricemia and renal failure remains inconclusive. Our results suggest that correction of hyperuricemia as a surrogate endpoint may not be associated with significant renal function improvement, particularly if renal dysfunction is unrelated to TLS.


Assuntos
Alopurinol/uso terapêutico , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Neoplasias/complicações , Insuficiência Renal/tratamento farmacológico , Insuficiência Renal/etiologia , Urato Oxidase/uso terapêutico , Adulto , Alopurinol/administração & dosagem , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/mortalidade , Razão de Chances , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Síndrome de Lise Tumoral/etiologia , Ácido Úrico/urina
16.
BMC Endocr Disord ; 20(1): 2, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906920

RESUMO

BACKGROUND: Several studies have shown that normal weight with central obesity (NWCO) is associated with cardiovascular disease risk factors such as hypertension, dyslipidemia and diabetes. However, the relationship between NWCO and hyperuricemia has not been studied in detail. METHODS: We investigated the association between NWCO and hyperuricemia among Japanese adults aged 40-64 years who had undergone periodic health examinations between April 2013 and March 2014. Obesity was defined as a body mass index (BMI) ≥25 kg/m2 and central obesity was determined as a waist-to-height ratio (WHtR) ≥0.5. We classified the participants into the following groups based according to having obesity and central obesity: normal weight (BMI 18.5-24.9 kg/m2) without (NW; WHtR < 0.5) and with (NWCO) central obesity, and obesity without (OB) and with (OBCO) central obesity. Hyperuricemia was defined as serum uric acid > 7.0 and ≥ 6.0 mg/dL in men and women, respectively, or under medical treatment for hyperuricemia. Alcohol intake was classified as yes (daily and occasional consumption) and none (no alcohol consumption). Odds ratios (OR) and 95% confidence intervals (CI) for hyperuricemia were calculated using a logistic regression model. RESULTS: We analyzed data derived from 96,863 participants (69,241 men and 27,622 women). The prevalences of hyperuricemia in men and women were respectively, 21.4 and 11.0%, and of participants with NWCO respectively 15.6 and 30.0%. The adjusted OR for hyperuricemia was significantly increased in OBCO compared with NW, regardless of sex (men: OR, 2.12; 95%CI; 2.03-2.21; women: OR, 3.54; 95%CI, 3.21-3.90) and were statistically significant in NWCO compared with NW (men: OR, 1.44; 95%CI, 1.36-1.52; women: OR, 1.41; 95%CI, 1.27-1.57). The results were similar regardless of alcohol consumption. CONCLUSIONS: We found that NWCO and OBCO were associated with hyperuricemia in middle-aged Japanese men and women. Middle-aged Japanese adults with normal weight but having central obesity should be screened using a combination of BMI and WHtR and educated about how to prevent hyperuricemia.


Assuntos
Índice de Massa Corporal , Peso Corporal , Hiperuricemia/epidemiologia , Obesidade Abdominal/complicações , Razão Cintura-Estatura , Adulto , Biomarcadores/análise , Estudos Transversais , Feminino , Seguimentos , Humanos , Hiperuricemia/etiologia , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
17.
Sci Rep ; 10(1): 815, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31965018

RESUMO

Hyperuricemia drives the development of nonalcoholic fatty liver disease (NAFLD). Pharmacological inhibition of xanthine oxidase (XO), a rate-limiting enzyme for uric acid (UA) production, has been demonstrated to improve hepatic steatosis in diet-induced obese mice. However, it remains unclear whether inhibition of XO improves nonalcoholic steatohepatitis (NASH), a more advanced form of NAFLD, in terms of both liver inflammation and fibrosis. Here, we investigated the effects of febuxostat and allopurinol, two XO inhibitors clinically used for gout, on a mouse model of NASH. Furthermore, we conducted a single-arm, open-label intervention study with febuxostat for NAFLD patients with hyperuricemia. Despite a similar hypouricemic effect of the XO inhibitors on blood UA level, febuxostat, but not allopurinol, significantly decreased hepatic XO activity and UA levels in the NASH model mice. These reductions in hepatic XO activity and UA levels were accompanied by attenuation of insulin resistance, lipid peroxidation, and classically activated M1-like macrophage accumulation in the liver. Furthermore, in NAFLD patients with hyperuricemia, treatment with febuxostat for 24 weeks decreased the serum UA level, accompanied by reductions in the serum levels of liver enzymes, alanine aminotransferase and aspartate aminotransferase. XO may represent a promising therapeutic target in NAFLD/NASH, especially in patients with hyperuricemia.


Assuntos
Alopurinol/farmacologia , Alopurinol/uso terapêutico , Dieta Hiperlipídica/efeitos adversos , Fígado Gorduroso/tratamento farmacológico , Fígado Gorduroso/metabolismo , Febuxostat/farmacologia , Febuxostat/uso terapêutico , Resistência à Insulina , Xantina Oxidase/antagonistas & inibidores , Animais , Modelos Animais de Doenças , Fígado Gorduroso/etiologia , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Peroxidação de Lipídeos/efeitos dos fármacos , Fígado/enzimologia , Ativação de Macrófagos/efeitos dos fármacos , Camundongos Endogâmicos C57BL , Terapia de Alvo Molecular , Ácido Úrico/metabolismo
18.
J Gastroenterol Hepatol ; 35(3): 473-481, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31414504

RESUMO

BACKGROUND AND AIM: Hepatitis C virus eradication via the use of antivirals ameliorates metabolic profiles. The changes in serum uric acid (SUA) levels in chronic hepatitis C patients who receive antivirals are not well understood. We aimed to address this issue by comparing the SUA changes before and after the achievement of a sustained virological response (which is defined as hepatitis C virus RNA seronegativity at 12 weeks after the end of treatment). METHODS: Two hundred and thirteen sustained virological response patients who were treated by directly acting antivirals were consecutively enrolled. Pretreatment and post-treatment SUA levels were compared. Hyperuricemia was defined as a uric acid level > 7.0 mg/dL in men and > 6.0 mg/dL in women. RESULTS: The SUA levels significantly decreased after treatment, as compared to the pretreatment levels (5.6 ± 1.5 vs 6.0 ± 1.7 mg/dL, respectively; P < 0.001). The proportion of hyperuricemia incidences significantly decreased after treatment (25.8% vs 35.7%, respectively; P = 0.001). The improvement was only observed in patients with a fibrosis-4 index (FIB-4) < 6.5 (25.7% vs 37.1%, P = 0.001) but not in those patients with a FIB-4 â‰§ 6.5 (26.3% vs 28.9%, P = 1.00). A multivariate analysis revealed that the factor that was associated with significantly decreased SUA levels was FIB-4 < 6.5 (odds ratio [OR]/95% confidence interval [CI]: 3.22/1.04-9.95, P = 0.04) and estimated glomerular filtration rate < 60 mL/min/1.73 m2 (OR/CI: 4.34/1.94-9.73, P < 0.001). There existed a trend of a higher proportion of patients with significant SUA improvement along with the decrement of FIB-4 (29.7%, 25%, and 10.5% in patients with FIB-4 < 3.25, 3.25-6.5, and > 6.5, respectively; trend P = 0.03). CONCLUSIONS: SUA levels were significantly decreased in chronic hepatitis C patients after viral eradication. The improvement was particularly enhanced in patients with mild liver disease.


Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Idoso , Feminino , Hepatite C Crônica/complicações , Humanos , Hiperuricemia/sangue , Cirrose Hepática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Resultado do Tratamento , Ácido Úrico/sangue
20.
Medicine (Baltimore) ; 98(42): e17597, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626136

RESUMO

Hyperuricemia has received increasing attention as a major public health problem. This study aims to investigate the risk factors for hyperuricemia and to explore the relationship between changes in biochemical variables and incident hyperuricemia.A cross-sectional and subsequently prospective study was performed among adults who took their health checkups at Zhejiang University Hospital. The participants who were free of hyperuricemia at baseline received annual follow-up examinations during a 6-year period. Cox proportional hazards regression analyses were conducted to calculate the risks for incident hyperuricemia.Of the 9238 participants enrolled, 1704 (18.4%) were diagnosed as hyperuricemia. During 21,757 person-years of follow-up, 1492 incident hyperuricemia cases were identified. The incidence of hyperuricemia was 68.58 cases per 1000 person-year of follow-up in the overall participants. The prevalence and the incidence of hyperuricemia increased greatly in female older than 50 years. High levels of BMI, SBP, FPG, TG, LDL-C, ALT, BUN, and creatinine increased the risk of hyperuricemia. Suffering fatty liver also increased the risk of hyperuricemia. Subjects with increasing DBP, TG, BUN, creatinine, or decreasing HDL-C were more likely to incident hyperuricemia.This study revealed that the change of diastolic blood pressure (DBP), serum triglycerides (TG), blood urea nitrogen (BUN), creatinine, and high-density lipoprotein cholesterol (HDL-C) level were independently associated with incident hyperuricemia.


Assuntos
HDL-Colesterol/sangue , LDL-Colesterol/sangue , Creatinina/sangue , Hiperuricemia/etiologia , Triglicerídeos/sangue , Ácido Úrico/sangue , Adulto , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Nitrogênio da Ureia Sanguínea , Índice de Massa Corporal , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Hiperuricemia/sangue , Hiperuricemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
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