Uric acid and the risk of kidney failure in primary glomerulonephritis patients with nephrotic syndrome: preliminary results of an ongoing single-center prospective study

M.  Kolesnyk; N.  Stepanova; L.  Snisar; L.  Lebid; V.  Nepomnyaschii; S.  Savchenko

doi:10.31450/ukrjnd.1(65).2020.05

M. Kolesnyk SI «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine» http://orcid.org/0000-0001-6658-3729
N. Stepanova SI «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine» http://orcid.org/0000-0002-1070-3602
L. Snisar SI «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine»
L. Lebid SI «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine»
V. Nepomnyaschii SI «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine»
S. Savchenko SI «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine»

DOI: https://doi.org/10.31450/ukrjnd.1(65).2020.05

Keywords: glomerulonephritis, nephrotic syndrome, serum uric acid, glomerular filtration rate, progression.

Abstract

The current study aimed to evaluate whether serum uric acid (SUA) level is associated with the risk of kidney failure in primary glomerulonephritis patients (PGN) with nephrotic syndrome.

Methods. During 2019, 38 patients with newly-diagnosed PGN and the nephrotic syndrome were prospectively considered for the study which is a fragment of the ongoing study "To evaluate the effect of oxalates and urates metabolism on the evolution of renal diseases".

In addition to routine clinical and laboratory examination, the concentration of serum (SUA) and urine uric acid was determined. According to the CKD-EPI formula, the glomerular filtration rate (GFR) was calculated. Hyperuricemia was considered to be a uric acid concentration ≥420 μmol / l (7 mg/dl) in men and ≥360 μmol / l (6 mg/dl) in women.

All patients enrolled in the study underwent a lifetime renal biopsy under ultrasound.

Results. There were 26/38 (68.4%) men and 12/38 (31.6%) women. The patients’ age ranged from 18 to 69 years and averaged 37 [28-48] years. The CKD duration at the time of hospitalization and carrying out the kidney biopsy was 11.0 [5,2-37,4] months.

Hyperuricemia was defined in 14/38 (37%) patients. SUA had an inverse correlation with the patients’ GFR (r = -0.44; p = 0.003). Uraturia level was associated with the chronic changes’ gradе on the kidney biopsy specimens (r = 0.66; p ˂ 0.00013).

A multivariate logistic analysis (adjustment for albumin, serum creatinine, total blood protein, daily proteinuria, patient age, and hypertension) SUA had an effect on the GFR level (OR 19.2 (95% CI 1.8; 209.5), χ² = 8.4; p = 0.003).

Conclusions. Hyperuricemia was observed in 37% of PGN patients with nephrotic syndrome and was an independent risk factor for CKD progression. Recruitment of patients continues to complete the statistical analysis and confirm our hypothesis. Patient recruitment is still ongoing to finalize the statistical analyses and to confirm our hypothesis.