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Open Access Research article

Plasma uric acid level indicates tubular interstitial leisions at early stage of IgA nephropathy

Jingjing Zhou1234, Yuqing Chen1234*, Ying Liu1234, Sufang Shi1234, Xueying Li5, Suxia Wang6 and Hong Zhang1234

Author Affiliations

1 Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China

2 Institute of Nephrology, Peking University, Beijing 100034, China

3 Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China

4 Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China

5 Department of Statistics, Peking University First Hospital, Beijing 100034, China

6 Laboratory of Electron Microscopy, Peking University First Hospital, Beijing 100034, China

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BMC Nephrology 2014, 15:11  doi:10.1186/1471-2369-15-11

Published: 14 January 2014

Abstract

Background

Hyperuricemia appeared to be a common symptom in IgA nephropathy (IgAN), even in those with normal eGFR. IgAN was characterized by variation of pathological features, especially variable tubulointerstitial lesions. Since tubular reabsorption and excretion appeared to be more important in determination of plasma uric acid levels in persons without obvious decrease of glomerular filtration rate, we took advantage of our IgAN cohort to investigate whether plasma uric acid level associated with tubular interstitial lesions, and could be considered as a maker for tubular interstitial lesions, especially at early stage with normal eGFR.

Methods

623 IgAN patients were involved in the present study. Morphological changes were evaluated with Oxford classification scoring system as well as Beijing classification system of IgAN. Statistical analysis was done with SPSS 13.0.

Results

We found that plasma uric acid level associated with percentage of interstitial fibrosis/tubular atrophy. Higher plasma uric acid levels indicated higher tubulointerstitial scores, either with Oxford system (P = 0.012) or with Beijing classification system (P = 4.8*10-4) in the whole cohort. We also found that in the subgroup of 258 IgAN cases with normal baseline eGFR (eGFR > =90 ml/min/1.73 M2), higher plasma uric acid associated with more severe tubulointerstitial lesions with Beijing scoring system (P = 3.4*10-5). The risk of having more than 10% tubulointerstitial lesions in patients with hyperuricemia increased 58% compared with normal uric acid level. In subgroup with normal eGFR, only hyperuricemia predicted tubulointerstitial leisions, and the risk of having more tubulointerstitial changes increased 100%. Among these patients, hyperuricemia was associated with more tubulointerstitial lesions with a specificity of 60.3%. Specificity increased to 65% among those patients with eGFR > =90 ml/min/1.73 m2.

Conclusions

Plasma uric acid levels indicate tubular interstitial lesions in IgAN and hyperuricemia may be considered as a marker for tubulointerstitial lesions.

Keywords:
IgA nephropathy; Plasma uric acid levels; Tubulointerstitial lesions