Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 437
Filtrar
1.
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
2.
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
3.
Ren Fail ; 41(1): 595-599, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31267805

RESUMO

The aim of this study was to evaluate the efficacy and tolerability of febuxostat in renal transplant recipients who were previously treated with allopurinol (the daily oral dose is 100 mg). A 6-month cohort study was conducted with 46 renal transplant recipients who had hyperuricemia. In 22 patients, treatment was changed from allopurinol to febuxostat (febuxostat was given at an oral dose of 20 mg once a day), and the other 24 patients continued the allopurinol treatment (the daily oral dose is 100 mg). The serum levels of uric acid (UA), creatinine, other biochemical parameters, estimated glomerular filtration rate (eGFR), and adverse events were measured at baseline as well as at 1, 3, and 6 months after the switch to febuxostat. Serum UA levels significantly decreased from 470.82 ± 34.37 to 378.77 ± 51.97 µmol/L in the febuxostat group, and decreased from 469.46 ± 33.47 to 428.21 ± 23.37 µmol/L in the allopurinol group. The eGFR increased from 75.55 to 85.23 mL/min in the febuxostat group, and decreased from 78.79 to 70.31 mL/min in the allopurinol group. In renal transplant recipients, febuxostat reduced the serum UA levels resulting in minor short-term improvement of renal function with no changes in the other biochemical parameters.


Assuntos
Alopurinol/administração & dosagem , Febuxostat/administração & dosagem , Supressores da Gota/administração & dosagem , Hiperuricemia/tratamento farmacológico , Transplante de Rim/efeitos adversos , Adulto , Aloenxertos/efeitos dos fármacos , Aloenxertos/fisiopatologia , Alopurinol/efeitos adversos , Substituição de Medicamentos , Febuxostat/efeitos adversos , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Supressores da Gota/efeitos adversos , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transplantados , Resultado do Tratamento , Ácido Úrico/sangue
4.
Lipids Health Dis ; 18(1): 147, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272481

RESUMO

BACKGROUND: Elevated serum uric acid is commonly associated with high triglyceride. However, the relation of triglyceride and hyperuricemia in different gender and age groups is currently not well understood. This study aimed to evaluate age- and gender-related association of high triglyceride with hyperuricemia in a subgroup of Chinese population. METHODS: We retrospectively analyzed physical examination data of 24,438 subjects (12,557 men and 11,881 women) in Kaifeng, China. The alanine aminotransferase, γ-glutamyl transpeptidase, serum creatinine, blood urea nitrogen, total cholesterol, high-density lipoprotein cholesterol, triglyceride and serum uric acid were measured in all subjects. The triglyceride was categorized into < 1.21, 1.21 ~, 1.7 ~, 2.83 ~ and >  5.6 mmol/L subgroups, and odds ratio (OR) and 95% confidence interval (CI) of hyperuricemia were calculated by logistic regression analysis. RESULTS: Univariate and age-adjusted analyses showed that high triglyceride was positively associated with hyperuricemia (p <  0.01). Further age-stratified analysis showed that the positive association was significant in the 20 ~, 30 ~, 40 ~, 50 ~, 60 ~ and 80 ~ age groups in men. In women, no statistically significant was found in 60 ~ and 70 ~ age groups. CONCLUSION: High triglyceride is positively associated with hyperuricemia in both men and women, and this association is age-related, especially in women.


Assuntos
Hiperuricemia/sangue , Triglicerídeos/sangue , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperuricemia/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Ácido Úrico/sangue , Adulto Jovem
5.
Niger Postgrad Med J ; 26(2): 138-141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31187755

RESUMO

Glycogen storage disease (GSD) is a rare inborn error of metabolism with an incidence of 1/20,000-40,000 live births. Some of the presenting clinical features can mimic diseases commonly seen in the tropics and subtropics. We report a 14-month-old Nigerian child who presented at our institution with GSD Type 111a to alert physicians on the need to consider and recognise this rare disorder. The child presented with progressive abdominal swelling due to marked hepatomegaly. From the clinical history, the only clue to hypoglycaemia was that she eats very frequently. Her random blood sugar was normal; however, fasting blood sugar was low. The diagnosis was further entertained with laboratory results showing hypercholesterolaemia and uricaemia and confirmed by histology of biopsied liver tissue. GSD should be suspected in a child with unexplained hepatomegaly and investigated accordingly.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Doença de Depósito de Glicogênio Tipo III/diagnóstico , Hepatomegalia/etiologia , Fígado/patologia , Biópsia , Feminino , Doença de Depósito de Glicogênio Tipo III/patologia , Humanos , Hipercolesterolemia/etiologia , Hiperuricemia/etiologia , Lactente , Fígado/metabolismo , Nigéria
6.
Transplant Proc ; 51(3): 692-700, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979452

RESUMO

BACKGROUND: Adequate kidney donor management after donation is increasingly emphasized due to concerns of renal function impairment after nephrectomy with increasing life expectancy. In this study, the clinical impact of a protocolized kidney donor follow-up system by nephrologists was evaluated. METHODS: A total of 427 living kidney donors underwent nephrectomy from January 2010 to December 2014 and were followed for at least 2 years at the Samsung Medical Center. Donors were followed-up by nephrologists after the establishment of a donor clinic with systemized protocols in January 2013. The primary outcomes were incidence of post-donation low estimated glomerular filtration rate (eGFR) and renal function adaptability. Secondary outcomes were changes in compliance and incidence of hyperuricemia and microalbuminuria. RESULTS: The patients were divided into 2 groups according to the time of nephrectomy: the pre-donor clinic period (n = 182) and the donor clinic period (n = 172). Preoperative eGFR in patients in the pre-donor clinic period was higher than that in patients in the donor clinic period. After donation, poor renal adaptation was less frequent in the donor clinic period compared to the pre-donor clinic period. Low eGFR tended to be less common during the donor clinic period. Shorter mean outpatient clinic visit intervals with more visits within 6 months after donation and earlier detection of de novo hyperuricemia were found during the donor clinic period. CONCLUSION: A protocolized donor clinic run by nephrologists may improve post-nephrectomy renal outcomes and compliance and facilitate better management of potential risk factors of chronic kidney disease in donors.


Assuntos
Doadores Vivos , Nefrectomia/efeitos adversos , Adulto , Albuminúria/epidemiologia , Albuminúria/etiologia , Estudos de Coortes , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Hiperuricemia/epidemiologia , Hiperuricemia/etiologia , Rim/fisiopatologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores de Risco
7.
Int Urol Nephrol ; 51(6): 1013-1018, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020628

RESUMO

PURPOSE: Hyperuricemia has been associated with higher mortality in the general population, but less is known about CKD patients. The aim of our study was to determine the impact of elevated serum uric acid on cardiovascular mortality of CKD patients who later progress to hemodialysis. METHODS: In this retrospective study, 120 CKD patients (entire population of patients with ESKD on January 1st, 2012) were observed from their first visit at the Nephrology outpatient clinic, while transitioning to hemodialysis, and until their death or January 1, 2016. After non-cardiovascular death exclusion, 83 CKD patients (33 female, 50 male) were left for further analysis. The average time of observation was 8.8 ± 4.2 years. Serum uric acid was measured regularly (every 3 months). No patients were treated for hyperuricemia. Mean uric acid of 420 µmol/L was set as a cut-off between normouricemic and hyperuricemic patients as per the laboratory's reference values. Survival rates were analyzed using Kaplan-Meier survival curves. Three Cox regression models were used to assess the influence of uric acid on survival. RESULTS: Mean uric acid was 379.8 ± 71.6 µmol/L (range 220-574). Sixty-three (75.9%) patients were normouricemic and 20 (24.1%) were hyperuricemic. Cholesterol was the only variable to show statistically significant difference (p = 0.004) between the groups. Bivariate analysis revealed an association between death and age, hyperuricemia, arterial hypertension, and history of cardiovascular disease. Kaplan-Meier survival analysis showed higher risk of cardiovascular death for hyperuricemic patients (log rank test; p < 0.0005). In Cox regression models, hyperuricemia remained a predictor of cardiovascular mortality (SE = 0.500, Exp(B) = 14.120, 95% CI 5.297-37.640) in our patients next to age and arterial hypertension. CONCLUSION: The results indicate an association between hyperuricemia and cardiovascular mortality in CKD patients who transition to hemodialysis.


Assuntos
Doenças Assintomáticas , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Hiperuricemia/etiologia , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Progressão da Doença , Feminino , Humanos , Hiperuricemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
PLoS One ; 14(2): e0212702, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789970

RESUMO

BACKGROUND: More than 11 million people were estimated to be infected by Schistosoma japonicum in China before the 1950s. However, seldom studies have been conducted to evaluate the longitudinal effects of previous schistosome infection (PSI). We aimed to investigate the association between PSI and hyperuricemia in China. METHODS: From February 2013 to October 2013, 3,517 Chinese subjects (908 persons with PSI and 2,609 persons without PSI) were recruited from a prospective cohort study of "135". After two years, 113 and 462 participants had developed hyperuricemia in the persons with and without PSI, respectively. Multivariable logistic models were used to estimate Relative Ratios (RR) and 95% confidence intervals (CIs) for hyperuricemia. RESULTS: The PSI participants had a decreased risk of hyperuricemia compared with those without PSI [adjusted RR (95%CI): 0.73 (0.55, 0.97)]. Within the PSI group, higher level of fasting plasma glucose was significantly associated with the reduced incidence of hyperuricemia in PSI population (RR: 0.40, 95% CI: 0.26-0.63). For females, hypertension, increased levels of serum creatinine and triglycerides were the risk factors for incident hyperuricemia in the PSI group. CONCLUSIONS: Our results suggest that PSI is significantly associated with the lower incidence of hyperuricemia. Moreover, elevated fasting plasma glucose might prevent the onset of hyperuricemia in PSI population.


Assuntos
Hiperuricemia/etiologia , Schistosoma/isolamento & purificação , Esquistossomose/complicações , Animais , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Rev Med Inst Mex Seguro Soc ; 56(5): 491-504, 2019 Jan 28.
Artigo em Espanhol | MEDLINE | ID: mdl-30777418

RESUMO

Scientific evidence has identified that the excessive consumption of products made from high-fructose corn syrup is a trigger for obesity, whose prevalence increased in recent years. Due to the metabolic characteristics of fructose, a rapid gastric emptying is produced, altering signals of hunger-satiety and decreasing the appetite. In addition to the hepatic level during catabolism, triose phosphate is generated and adenosine triphosphate (ATP) is reduced, producing uric acid. Triose phosphate triggers the synthesis of fatty acids that increase the production and accumulation of triglycerides, diacylglycerols and ceramides that induce insulin resistance. Hyperlipidemia, insulin resistance and hyperuricemia contribute to the development of hypertension, cardiovascular disease, kidney failure, non-alcoholic fatty liver disease and some kinds of cancer. Understanding the molecular mechanisms and signaling pathways altered by the consumption of fructose is relevant to understand the development of metabolic diseases, as well as to seek therapeutic strategies to improve quality of life.


Assuntos
Metabolismo dos Carboidratos , Açúcares da Dieta/efeitos adversos , Frutose/efeitos adversos , Metabolismo dos Lipídeos , Doenças Metabólicas/etiologia , Biomarcadores/metabolismo , Açúcares da Dieta/metabolismo , Frutose/metabolismo , Humanos , Hiperlipidemias/etiologia , Hiperuricemia/etiologia , Resistência à Insulina , Doenças Metabólicas/metabolismo
10.
Ann Hematol ; 98(5): 1101-1110, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30721337

RESUMO

Thalassemia patients have a high cell turnover rate due to chronic hemolysis and ineffective erythropoiesis; therefore, hyperuricemia is anticipated. This study aimed to identify the prevalence of hyperuricemia, gout and nephrolithiasis, conditions associated with serum uric acid (SUA), and urine uric acid excretion (UUA) in thalassemia patients. This was a cross-sectional study in patients aged 15 years or older at Chiang Mai University Hospital. All patients had blood and 24-h urine collection test. We enrolled 112 thalassemia patients in which 67.0% were female, 64.3% had beta thalassemia/Hb E, 76.8% were transfusion dependent, and 59.8% were post splenectomy. The median age was 29 (16-58) years. Mean SUA was 6.7 ± 2.0 mg/dl and hyperuricemia (SUA > 6.8 mg/dl) was found in 47 cases (45.2%). Intact spleen (ORs 4.3, 95%CI 1.55-12.50, p = 0.01) and lower FEuric (ORs 2.08, 95%CI 1.35-3.33, p < 0.01) were associated with hyperuricemia significantly. Seven (6.3%) had gouty arthritis and nine (8%) had microscopic hematuria, one case being confirmed nephrolithiasis. The mean UUA excretion was 981.3 ± 335.0 mg/day and UUA hyperexcretion (> 700 mg/24 h) was found in 83.3%. UUA hyperexcretion patients had renal hyperfiltration 46%, glomerular dysfunction 84%, and tubular dysfunction 7.7%. From our study, hyperuricemia was found in approximately 40% of thalassemia patients but gouty arthritis occurred only in few patients (6%). This may be explained by urinary uric hyperexcretion which is found in over 80%. The significant risk factors for hyperuricemia were intact spleen and lower fraction excretion of uric acid.


Assuntos
Artrite Gotosa , Hematúria , Hiperuricemia , Talassemia beta , Adolescente , Adulto , Artrite Gotosa/sangue , Artrite Gotosa/etiologia , Artrite Gotosa/urina , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Hematúria/sangue , Hematúria/etiologia , Hematúria/urina , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Hiperuricemia/urina , Masculino , Pessoa de Meia-Idade , Esplenectomia , Ácido Úrico , Talassemia beta/sangue , Talassemia beta/complicações , Talassemia beta/cirurgia , Talassemia beta/urina
11.
ESC Heart Fail ; 6(2): 336-343, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30620450

RESUMO

AIMS: Plasma xanthine oxidoreductase (XOR) activity during the acute phase of acute heart failure (AHF) requires further elucidation. METHODS AND RESULTS: One hundred eighteen AHF patients and 231 control patients who attended a cardiovascular outpatient clinic were prospectively analysed. Blood samples were collected within 15 min of admission from AHF patients (AHF group) and control patients who visited a daily cardiovascular outpatient clinic (control group). Plasma XOR activity was compared between the two groups, and factors independently associated with extremely elevated XOR activity were identified using a multivariate logistic regression model. Plasma XOR activity in the AHF group (median, 104.0 pmol/h/mL; range, 25.9-423.5 pmol/h/mL) was significantly higher than that in the control group (median, 45.2 pmol/h/mL; range, 19.3-98.8 pmol/h/mL). The multivariate logistic regression model showed that serum uric acid (per 1.0 mg/dL increase, odds ratio: 1.280; 95% confidence interval: 1.066-1.536; P = 0.008) and lactate levels (per 1.0 mmol/L increase, odds ratio: 1.239; 95% confidence interval: 1.040-1.475; P = 0.016) were independently associated with high plasma XOR activity (>300 pg/h/mL) during the acute phase of AHF. CONCLUSIONS: Plasma XOR activity was extremely high in patients with severely decompensated AHF. This would be associated with a high lactate value and would eventually lead to hyperuricaemia in patients with AHF.


Assuntos
Cuidados Críticos/métodos , Insuficiência Cardíaca/sangue , Xantina Desidrogenase/sangue , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Masculino , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Ácido Úrico/sangue
12.
Behav Pharmacol ; 30(1): 89-94, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29847340

RESUMO

The development of Parkinson's disease (PD) involves the degeneration of dopaminergic neurons caused by oxidative stress. Accumulating clinical evidence indicates that high blood levels of uric acid (UA), an intrinsic antioxidative substance, are associated with reduced risk of PD. However, this hypothesis has not been confirmed by in-vivo experiments. The present study investigated the effects of UA on behavioral abnormalities in the development of PD. We used unilateral 6-hydroxydopamine-lesioned mice, which were fed on a diet containing 1% UA and 2.5% potassium oxonate (an uricase inhibitor) to induce hyperuricemia. A significant elevation in UA levels was found in groups that were fed a UA diet. The 6-hydroxydopamine-lesioned mice showed impaired rotarod performance and increased apomorphine-induced contralateral rotations. These behavioral abnormalities were significantly reversed by feeding a UA diet for 1 week before and 5 weeks after surgery (subchronic hyperuricemia). These behavioral improvements occurred in parallel with recovery of tyrosine hydroxylase protein levels in the lesioned striatal side. The present study with a dietary hyperuricemia mice model confirms that UA exerts a neuroprotective effect on dopaminergic neuronal loss, improving motor dysfunction and ameliorating PD development.


Assuntos
Transtornos Mentais/sangue , Transtornos Mentais/etiologia , Doença de Parkinson Secundária/complicações , Ácido Úrico/sangue , Adrenérgicos/toxicidade , Animais , Apomorfina/farmacologia , Modelos Animais de Doenças , Hiperuricemia/sangue , Hiperuricemia/etiologia , Masculino , Transtornos Mentais/dietoterapia , Camundongos , Camundongos Endogâmicos ICR , Atividade Motora/efeitos dos fármacos , Oxidopamina/toxicidade , Ácido Oxônico/administração & dosagem , Doença de Parkinson Secundária/induzido quimicamente , Teste de Desempenho do Rota-Rod , Tirosina 3-Mono-Oxigenase/metabolismo
13.
Semin Dial ; 32(1): 47-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29989213

RESUMO

Uric acid-mediated biological effects are milieu dependent. In a physiological milieu, serum uric acid serves as an antioxidant; when homeostasis is perturbed, divergent effects are observed depending on the clinical context. Several epidemiologic studies indicated the presence of a direct relationship between higher concentrations of serum uric acid and cardiovascular mortality; yet not all studies support this conclusion. Although high serum levels of uric acid are associated with higher mortality in patients with nondialysis-dependent chronic kidney disease and perhaps in those with end-stage kidney disease receiving peritoneal dialysis, the opposite relationship is seen in patients with end-stage kidney disease on hemodialysis. This review discusses the pathologic mechanisms associated with elevated serum uric acid levels by clinical context; examines the interplay between uric acid metabolism and modality of renal replacement therapy; and presents hypotheses to rationalize the disparate associations between incremental levels of serum uric acid and survival across the continuum of kidney disease and by type of renal replacement therapy.


Assuntos
Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Ácido Úrico/sangue , Feminino , Humanos , Hiperuricemia/etiologia , Hiperuricemia/fisiopatologia , Falência Renal Crônica/diagnóstico , Masculino , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Prognóstico , Diálise Renal/métodos , Medição de Risco , Taxa de Sobrevida
14.
Eur J Clin Invest ; 49(2): e13044, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30368802

RESUMO

BACKGROUND: Heart failure (HF) is a major public health problem and represents the only cardiac disease continuing to increase in prevalence, in particular among elderly patients. The frequent rehospitalizations have a negative impact on quality of life of patients with HF, constituting a substantial cost for patients and the health system. The aim of this review was to look into biochemical, echocardiographic and socioeconomical parameters as predictors of clinical outcomes and rehospitalizations. METHODS: This narrative review is based on the material searched for and obtained via PubMed from January 2000 up to March 2018. The search terms we used were as follows: "elderly, heart failure, cardiovascular" in combination with "biomarker, echocardiography and hospitalization." RESULTS: This review analyses the potential predictive role of biochemical and echocardiographic and socioeconomical parameters on clinical outcomes (particularly cardiovascular) and hospital readmissions in patients with chronic HF. We focused on risk stratification of elderly patients with HF, who constitute a category of frail subjects at higher risk for readmission to hospital. CONCLUSIONS: In elderly subjects with chronic HF, the risk stratification could benefit of a multiparametric approach combining biochemical, echocardiographic, demographic and socioeconomical parameters, thus ensuring a better quality of life and at the same time a better allocation of financial resources.


Assuntos
Insuficiência Cardíaca/terapia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Anemia/sangue , Anemia/etiologia , Biomarcadores/metabolismo , Proteína C-Reativa/metabolismo , Síndrome Cardiorrenal/sangue , Síndrome Cardiorrenal/etiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Doença Crônica , Ecocardiografia , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Hiponatremia/sangue , Hiponatremia/etiologia , Peptídeos Natriuréticos/metabolismo , Hormônio Paratireóideo/metabolismo , Fatores de Risco , Volume Sistólico/fisiologia , Troponina/metabolismo , Vitamina D/metabolismo
15.
BMC Psychiatry ; 18(1): 390, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563493

RESUMO

BACKGROUND: Clinical studies have shown that bipolar patients have increased serum uric acid levels. High serum uric acid levels could play a role contributing to high prevalence of metabolic syndrome. Metabolic syndrome is known to increase the risk of developing a number of life threatening diseases including coronary heart disease, hypertension, and type 2 diabetes. This study investigated the association between hyperuricemia and metabolic syndrome and its components in individuals suffering from bipolar disorders. METHODS: This study recruited 318 inpatients suffering from bipolar disorders from Beijing Hui-Long-Guan Hospital in China and 160 healthy subjects from the same region as the controls. We used National Cholesterol Education Program Adult Treatment Panel III Adapted criteria (NCEP ATP-III A) for the diagnosis of metabolic syndrome. Hyperuricemia was determined as serum uric acid level above 420 µmol/L in men and 360 µmol/L in women (N Engl J Med 359(17):1811-1821, 2008). RESULTS: Among 318 bipolar patients, there was higher prevalence of metabolic syndrome (42.5%) and hyperuricemia (27.7%) than healthy controls (21.9 and 11.9%). Bipolar patients with metabolic syndrome had increased prevalence of hyperuricemia (OR = 3.0, CI95 [1.7-5.4]). Hypertriglyceridemia and larger waist circumference (WC) were associated with hyperunicemia (OR = 1.8, CI95 [1.1-3.1], OR = 1.9, CI95 [1.1-3.4]). Hyperuricemia was associated with metabolic syndrome in bipolar patients (p < 0.001) and especially with hypertriglyceridemia (OR = 1.9, CI95 [1.1-3.1] and increased WC (OR = 2.1 [1.2-4.0]). Bipolar patients over 50 years of age and hyperuricemia were highly prone to develop metabolic syndrome (OR = 14.0, CI95 [5.0-39.0]). CONCLUSIONS: Hyperuricemia was highly associated with development of metabolic disorder particularly for aged patients suffering from bipolar disorders. Early prevention of hyperuricemia and metabolic syndrome may lead better life for bipolar patients when they get older.


Assuntos
Transtorno Bipolar , Hiperuricemia , Síndrome Metabólica , Adulto , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/metabolismo , China/epidemiologia , Comorbidade , Correlação de Dados , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/epidemiologia , Hiperuricemia/etiologia , Hiperuricemia/prevenção & controle , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/prevenção & controle , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , Prevalência , Ácido Úrico/sangue , Circunferência da Cintura
16.
Saudi J Kidney Dis Transpl ; 29(5): 1050-1056, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30381500

RESUMO

Hyperuricemia [serum uric acid (SUA) >7.0 mg/dL] which is common in chronic renal diseases is associated with augmented vascular events. In addition to nonpharmacological therapy, hypouricosuric drugs reduce UA levels. The current study was a prospective observational study of six months duration November 2016 to April 2017 done to determine the efficacy of febuxostat in patients with hyperuricemia in chronic kidney disease (CKD) stage G3a to G5 and to correlate any association with reduction of hypertension, improvement in glomerular filtration rate (GFR), and reduction in comorbidities. The study was carried out at the Department of Nephrology, Owaisi Hospital and Research Center, Hyderabad. One hundred and ten patients were screened, of which 53 patients wherein stage G3a to G5 were recruited and SUA levels were obtained after inclusion criteria. SUA >6.0 in females and 7.0 in males were recruited. The drug febuxostat 40 mg was given once day to all patients with stage G3a to G5D with elevate uric acid levels >7.0 in males and more than 6.0 in females and three samples of UA were obtained monthly. The mean of GFR, blood pressure (BP), and SUA levels were obtained before and after the therapy. Of the 53 patients, males were 32 (60.3%), and females were 21 (39.6%). Mean age of the patients were 36.5 years. Mean UA levels before the start of febuxostat therapy were 8.6, and after adding febuxostat, it was 5.10 at the end of the third visit. The mean BP drop was 7.2 ± 2.1 mm in systolic BP (from 154-147 mm Hg) and diastolic BP drop was 93 ± 2.5 mm Hg (5.1 mm Hg). The mean GFR improved from 50.3 to 53.3 mL/min after the start of febuxostat. Febuxostat in asymptomatic CKD patients improves UA levels, BP and estimated GFR at low dose without any adverse events and no cardiac-related events.


Assuntos
Febuxostat/uso terapêutico , Supressores da Gota/uso terapêutico , Hiperuricemia/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Ácido Úrico/sangue , Adulto , Biomarcadores/sangue , Febuxostat/efeitos adversos , Feminino , Supressores da Gota/efeitos adversos , Humanos , Hiperuricemia/sangue , Hiperuricemia/diagnóstico , Hiperuricemia/etiologia , Índia , Masculino , Estudos Prospectivos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
17.
World J Gastroenterol ; 24(43): 4920-4927, 2018 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-30487701

RESUMO

AIM: To describe the prevalence of posttransplant metabolic syndrome (PTMS) after donation after cardiac death (DCD) liver transplantation (LT) and the pre- and postoperative risk factors. METHODS: One hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre- and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-III criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT. RESULTS: The prevalence of PTMS after DCD donor orthotopic LT was 20/147 (13.6%). Recipient's body mass index (P = 0.024), warm ischemia time (WIT) (P = 0.045), and posttransplant hyperuricemia (P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients (P < 0.001). After the 1st mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function. CONCLUSION: PTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.


Assuntos
Hiperuricemia/epidemiologia , Transplante de Fígado/efeitos adversos , Síndrome Metabólica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Isquemia Quente/efeitos adversos , Adulto , Biomarcadores/sangue , Seleção do Doador/métodos , Doença Hepática Terminal/cirurgia , Feminino , Seguimentos , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Transplante de Fígado/métodos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Doadores de Tecidos/estatística & dados numéricos , Resultado do Tratamento , Ácido Úrico/sangue
18.
High Alt Med Biol ; 19(4): 373-381, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30358417

RESUMO

OBJECTIVE: Clinical studies have shown that oral vitamin C supplementation can reduce serum uric acid levels in multiple populations and may also improve acute mountain sickness. However, it is unclear whether this protocol can improve high-altitude hyperuricemia. Therefore, we aimed to evaluate the role of vitamin C supplementation on high-altitude hyperuricemia. METHODS: A preliminary prospective control study was performed in 2015. Young male army recruits (n = 66), who had recently arrived on the Tibetan Plateau for the first time, were recruited for study I. Subjects were assigned to either the vitamin C group, who took an oral daily dose of 500 mg vitamin C for 1 month, or the blank control group, who had no intervention. The levels of serum uric acid, serum creatinine, and blood urea nitrogen were monitored at baseline and at the end of 1 month. In a second study II in 2016 (n = 120), the effect of 500 mg/d vitamin C on high-altitude hyperuricemia was compared with 75 IU/d of vitamin E. RESULTS: In study I, the level of serum uric acid at 1 month was significantly higher than at baseline (436.1 ± 79.3 µmol/L vs. 358.0 ± 79.8 µmol/L, p < 0.001) and the prevalence of hyperuricemia was also significantly higher (63.6% [95% confidence interval, CI: 52.0%-75.2%] vs. 19.7% [95% CI: 10.1%-29.3%], p < 0.001). Both the level of serum uric acid (411.5 ± 74.2 µmol/L vs. 460.8 ± 54.8 µmol/L, p = 0.003) and the prevalence of hyperuricemia (48.5% [95% CI: 31.4%-65.6%] vs. 78.8% [95% CI: 64.9%-92.7%], p = 0.020) were significantly lower in the vitamin C group than in the blank control group. In study II, the levels of serum uric acid and the frequency of hyperuricemia also increased over 1 month and were similar in the vitamin C and the vitamin E groups at both baseline and 1 month (p > 0.05). The change in serum uric acid was positively correlated with both the changes in serum creatinine (r = 0.599, p < 0.001) and blood urea nitrogen (r = 0.207, p = 0.005). CONCLUSIONS: These findings indicate that healthy young men develop an increase in serum uric acid within a month of moving from low to high altitude. Oral vitamin C supplementation can safely reduce this increase at a low cost.


Assuntos
Altitude , Ácido Ascórbico/administração & dosagem , Suplementos Nutricionais , Hiperuricemia/terapia , Vitaminas/administração & dosagem , Adolescente , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Humanos , Hiperuricemia/sangue , Hiperuricemia/etiologia , Masculino , Projetos Piloto , Resultado do Tratamento , Ácido Úrico/sangue , Vitamina E/administração & dosagem , Adulto Jovem
19.
J Med Invest ; 65(3.4): 151-161, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30282853

RESUMO

The author reviewed recent reports about the blood levels and dietary intake of polychlorinated dibenzo-p-dioxins (PCDDs)/furans (PCDFs)/dioxin-like polychlorinated biphenyls (DL-PCBs) to investigate the trends of dioxin exposure, and epidemiologic studies on the associations of blood levels of dioxins with metabolic diseases. In recent years, dietary intake of dioxins has been decreasing, and the means are equal to or less than 1.0 pg Toxic Equivalents (TEQ)/kg/day in the general populations of several countries. The blood levels of dioxins are also decreasing, probably because of reduced dietary intake. Many cross-sectional studies reported positive associations between blood levels of some isomers or TEQ-based concentrations of PCDDs/PCDFs/DL-PCBs and diabetes in general populations. Three cohort studies on populations with heavy exposure and two nested case-control studies on general populations have also been published, but the results are inconsistent. Three large-scale cross-sectional studies and two cohort studies reported an association between blood levels of some isomers or TEQ-based concentrations of PCDDs/PCDFs/DL-PCBs and metabolic syndrome. In addition, three cross-sectional studies reported significant positive associations with gout/hyperuricemia. Further prospective studies and experimental studies are needed to establish cause-effect relationships, and to clarify the biological mechanisms for the association between background exposure to dioxins and potential health effects. J. Med. Invest. 65:151-161, August, 2018.


Assuntos
Poluentes Ambientais/toxicidade , Bifenilos Policlorados/toxicidade , Diabetes Mellitus/etiologia , Dibenzofuranos Policlorados/sangue , Dibenzofuranos Policlorados/toxicidade , Dioxinas/sangue , Dioxinas/toxicidade , Exposição Ambiental/efeitos adversos , Poluentes Ambientais/sangue , Contaminação de Alimentos/análise , Gota/etiologia , Humanos , Hiperuricemia/etiologia , Síndrome Metabólica/etiologia , Bifenilos Policlorados/sangue , Dibenzodioxinas Policloradas/sangue , Dibenzodioxinas Policloradas/toxicidade
20.
Pharmacotherapy ; 38(11): 1106-1119, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30246299

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of lesinurad for the treatment of hyperuricemia in patients with gout. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). PATIENTS OR PARTICIPANTS: Five RCTs, which included 1959 patients, compared the efficacy and safety of lesinurad in patients with hyperuricemia associated with gout. MEASUREMENTS AND RESULTS: Relevant studies were identified from PubMed, EMBASE, Cochrane Library databases, and the ClinicalTrials.gov registry. Two reviewers independently assessed the studies. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate the pooled effect size by using a random-effect model. The primary outcomes were the proportion of patients achieving target serum uric acid (sUA) levels by month 6 and the mean sUA levels at month 6 and month 12. Gout-related outcomes were also assessed. The secondary outcome was the number of treatment-emergent adverse events (TEAEs). Compared with xanthine oxidase inhibitor (XOI) monotherapy, lesinurad 200 mg or 400 mg in combination with allopurinol or febuxostat exhibited a higher proportion of patients achieving target sUA levels of < 6.0 mg/dl or < 5.0 mg/dl, respectively, by month 6. Lesinurad-plus-XOI groups also significantly sustained lower mean sUA levels at month 6 and month 12 compared to XOI alone group. In gout-related outcomes, no significant treatment group differences favored lesinurad. The number of TEAEs was comparable between the lesinurad 200 mg-plus-XOI group and the XOI-monotherapy group. Although lesinurad 400 mg monotherapy demonstrated superior efficacy compared with placebo, significantly more TEAEs occurred. CONCLUSIONS: Although the combination of lesinurad 200 mg and XOI is effective and well tolerated for treating patients with gout who have not achieved an adequate response to XOI monotherapy, clinical gout-related outcomes were not improved. Therefore, additional studies investigating the long-term clinical implication of lesinurad are warranted.


Assuntos
Gota/tratamento farmacológico , Hiperuricemia/tratamento farmacológico , Tioglicolatos/administração & dosagem , Tioglicolatos/uso terapêutico , Triazóis/administração & dosagem , Triazóis/uso terapêutico , Uricosúricos/administração & dosagem , Uricosúricos/uso terapêutico , Gota/complicações , Humanos , Hiperuricemia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tioglicolatos/efeitos adversos , Triazóis/efeitos adversos , Uricosúricos/efeitos adversos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA