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In-depth review
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Korean J Med. 2025;100(3):109-121. Published online June 1, 2025.
DOI: https://doi.org/10.3904/kjm.2025.100.3.109
- 만성 콩팥병에서 고요산혈증은 왜 중요한가?
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김수현
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중앙대학교 의과대학 중앙대학교광명병원 신장내과
- Hyperuricemia: Does it Matter in Chronic Kidney Disease?
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Su Hyun Kim
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Division of Nephrology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
- Corresponding author: Su Hyun Kim ,Tel: +82-2-2610-6765, Fax: +82-2-6299-2626, Email: sh76so@cau.ac.kr
- Received: March 8, 2025; Revised: April 15, 2025 Accepted: April 17, 2025.
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߽ɾ :고요산혈증; 만성 콩팥병; 요산; 인플라마솜; 레닌-안지오텐신 시스템
- Abstract
- Chronic kidney disease (CKD) affects approximately 10-15% of adults globally and is a significant public health issue owing to its association with cardiovascular disease, end-stage kidney disease, and high healthcare costs. Hyperuricemia has emerged as an important modifiable risk factor influencing CKD progression. Elevated uric acid (UA) levels contribute to kidney injury through crystal-dependent mechanisms, including monosodium urate crystal deposition and NLRP3 inflammasome activation, and crystal-independent pathways, such as endothelial dysfunction, activation of the renin-angiotensin-aldosterone system, and oxidative stress. Observational studies have consistently linked hyperuricemia to an increased risk of CKD onset and accelerated disease progression. Nevertheless, randomized controlled trials and meta-analyses investigating UA-lowering therapy (ULT) for asymptomatic hyperuricemia have yielded conflicting results regarding its effectiveness in slowing CKD progression. Clinical guidelines also differ: Japanese guidelines recommend ULT for serum UA levels exceeding 8.0 mg/dL, whereas Western guidelines generally do not support routine treatment of asymptomatic hyperuricemia. Thus, there remains a clear need for large-scale, long-term studies to define patient subgroups most likely to benefit from ULT and guide individualized treatment approaches.
Keywords :Hyperuricemia, Renal insufficiency, chronic, Uric acid, Inflammasomes, Renin-angiotensin system
