Reappraisal of the pathogenesis and consequences of hyperuricemia in hypertension, cardiovascular disease, and renal disease

An elevated uric acid level is associated with cardiovascular disease. Hype ruricemia is predictive for the development of both hypertension and corona ry artery disease; it is increased in patients with hypertension, and, when present in hypertension, an elevated uric acid level is associated with in creased cardiovascular morbidity and mortality. Serum uric acid level shoul d be measured in patients at risk for coronary artery disease because it ca rries prognostic information. Hyperuricemia is caused by decreased renal ex cretion. In this article, we suggest that this may be mediated by intrarena l ischemia with lactate generation and the inhibition of the secretion of u rate by the anion exchange transport system. The possibility that hyperuric emia directly contributes to cardiovascular or renal disease needs to be re considered. Although hyperuricemia is associated with a number of cardiovas cular or renal risk factors, several studies have found uric acid level to be independently associated with increased mortality by multivariate analys is. If hyperuricemia is directly toxic, the most likely site is the kidney. Chronic hyperuricemia is strongly associated with chronic tubulointerstiti al disease, and many of these patients have decreased renal function. Altho ugh it is possible that the hyperuricemia could simply be the consequence o f the renal disease, further studies are necessary to rule out a pathogenic role for uric acid in the development of renal disease and salt-dependent hypertension. (C) 1999 by the National Kidney Foundation, Inc.