Technical specifcation for diagnosis and treatment of hyperuricemia after renal transplantation in China(2019 edition)
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摘要: 为了进一步规范中国肾移植术后高尿酸血症的诊断和治疗, 中华医学会器官移植学分会组织器官移植专家和内分泌专家, 总结国内外有关器官移植术后尿酸代谢异常研究最新进展并参考《中国肾脏疾病高尿酸血症诊治的实践指南(2017版)》, 结合临床实践, 从高尿酸血症的诊断与分型、病因、引起器官功能障碍的机制、高尿酸血症与痛风的治疗等方面, 制定中国肾移植术后高尿酸血症诊疗技术规范(2019版)。
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表 1 高尿酸血症的分型
Table 1. Typing of hyperuricemia
分型 尿酸排泄
[μmol/(kg·h)]Cua
(mL/min)Cua/Ccr
(%)尿酸排泄不良型 < 2.86 <6.2 <5 尿酸生成过多型 > 3.00 ≥6.2 > 10 混合型 > 3.00 < 6.2 5~10 尿酸排泄 =24 h 尿酸排泄量(μmol) / 体质量(kg) /24;尿酸清除率(Cua) =UUA× 平均每分钟尿量 /SUA; Ccr(男性) =(140– 年龄)× 体质量(kg) /[0.818×Scr(μmol/L) ]; Ccr(女性) =(140– 年龄)× 体质量(kg) /[0.818×Scr(μmol/L)]×0.85;Ccr 为肌酐清除率; Scr 为血清肌酐 -
[1] BELLOMO G.Asymptomatic hyperuricemia following renal transplantation[J].World J Nephrol, 2015, 4(3):324-329.DOI: 10.5527/wjn.v4.i3.324. [2] KALANTAR E, KHALILI N, HOSSIENI MS, et al.Hyperuricemia after renal transplantation[J].Transplant Proc, 2011, 43(2):584-585.DOI: 10.1016/j.transproceed.2011.01.062. [3] MALHEIRO J, ALMEIDA M, FONSECA I, et al.Hyperuricemia in adult renal allograft recipients:prevalence and predictors[J].Transplant Proc, 2012, 44(8):2369- 2372.DOI: 10.1016/j.transproceed.2012.07.033. [4] NUMAKURA K, SATOH S, TSUCHIYA N, et al.Hyperuricemia at 1 year after renal transplantation, its prevalence, associated factors, and graft survival[J].Transplantation, 2012, 94(2):145-151.DOI: 10.1097/TP.0b013e318254391b. [5] CLIVE DM.Renal transplant-associated hyperuricemia and gout[J].J Am Soc Nephrol, 2000, 11(5):974-979. http://d.old.wanfangdata.com.cn/NSTLQK/NSTL_QKJJ028136156/ [6] KIM KM, KIM SS, HAN DJ, et al.Hyperuricemia in kidney transplant recipients with intact graft function[J].Transplant Proc, 2010, 42(9):3562-3567.DOI: 10.1016/j.transproceed.2010.07.104. [7] 中国医师协会肾脏内科医师分会.中国肾脏疾病高尿酸血症诊治的实践指南(2017版)[J].中华医学杂志, 2017, 97(25):1927-1936.DOI:10.3760/cma.j.issn.0376- 2491.2017.25.003.Branch of Kidney Physicians of Chinese Physicians Association.Guidelines for the diagnosis and treatment of hyperuricemia in renal diseases in China (2017 edition)[J].Natl Med J China, 2017, 97(25):1927-1936.DOI:10.3760/cma.j.issn.0376- 2491.2017.25.003.cma.j.issn.0376-2491.2017.25.003. [8] BAHN A, HAGOS Y, REUTER S, et al.Identification of a new urate and high affinity nicotinate transporter, hOAT10 (SLC22A13)[J].J Biol Chem, 2008, 283(24):16332- 16341.DOI: 10.1074/jbc.M800737200. [9] KANBAY M, AKCAY A, HUDDAM B, et al.Influence of cyclosporine and tacrolimus on serum uric acid levels in stable kidney transplant recipients[J].Transplant Proc, 2005, 37(7):3119-3120. doi: 10.1016/j.transproceed.2005.08.042 [10] ZAWIASA A, SZKLAREK-KUBICKA M, FIJAŁKOWSKAMORAWSKA J, et al.Effect of oral fructose load on serum uric acid and lipids in kidney transplant recipients treated with cyclosporine or tacrolimus[J].Transplant Proc, 2009, 41(1):188-191.DOI: 10.1016/j.transproceed.2008.10.038. [11] OLYAEI AJ, DE MATTOS AM, BENNETT WM.Nephrotoxicity of immunosuppressive drugs:new insight and preventive strategies[J].Curr Opin Crit Care, 2001, 7(6):384-389. doi: 10.1097/00075198-200112000-00003 [12] EL-SHEIKH AA, VAN DEN HEUVEL JJ, KOENDERINK JB, et al.Effect of hypouricaemic and hyperuricaemic drugs on the renal urate efflux transporter, multidrug resistance protein 4[J].Br J Pharmacol, 2008, 155(7):1066-1075.DOI: 10.1038/bjp.2008.343. [13] YOSHIMURA N, USHIGOME H, MATSUYAMA M, et al.The efficacy and safety of high-dose mizoribine in ABO-incompatible kidney transplantation using antiCD20 and anti-CD25 antibody without splenectomy treatment[J].Transplant Proc, 2012, 44(1):140-143.DOI: 10.1016/j.transproceed.2011.12.009. [14] TAKAHARA S, TAKAHASHI K, AKIYAMA T, et al.Randomized comparative trial of mizoribine versus mycophenolate mofetil in combination with tacrolimus for living donor renal transplantation[J].Clin Exp Nephrol, 2013, 17(6):899-904.DOI: 10.1007/s10157-013-0780-1. [15] SHI Y, LIU H, CHEN XG, et al.Comparison of mizoribine and mycophenolate mofetil with a tacrolimus-based immunosuppressive regimen in living-donor kidney transplantation recipients:a retrospective study in China[J].Transplant Proc, 2017, 49(1):26-31.DOI: 10.1016/j.transproceed.2016.10.018. [16] SUGITANI A, KITADA H, OTA M, et al.Revival of effective and safe high-dose mizoribine for the kidney transplantation[J].Clin Transplant, 2006, 20(5):590-595. doi: 10.1111/ctr.2006.20.issue-5 [17] NISHIMURA K, UCHIDA K, YUZAWA K, et al.Excellent results with high-dose mizoribine combined with cyclosporine, corticosteroid, and basiliximab in renal transplant recipients:multicenter study in Japan[J].Transplant Proc, 2012, 44(1):147-149.DOI: 10.1016/j.transproceed.2011.11.015. [18] IWANAGA T, SATO M, MAEDA T, et al.Concentration-dependent mode of interaction of angiotensin Ⅱ receptor blockers with uric acid transporter[J].J Pharmacol Exp Ther, 2007, 320(1):211-217. http://www.ncbi.nlm.nih.gov/pubmed/17043154 [19] HONG Q, QI K, FENG Z, et al.Hyperuricemia induces endothelial dysfunction via mitochondrial Na+/Ca2+ exchanger-mediated mitochondrial calcium overload[J].Cell Calcium, 2012, 51(5):402-410.DOI: 10.1016/j.ceca.2012.01.003. [20] SAITO I, SARUTA T, KONDO K, et al.Serum uric acid and the renin-angiotensin system in hypertension[J].J Am Geriatr Soc, 1978, 26(6):241-247. doi: 10.1111/jgs.1978.26.issue-6 [21] KANELLIS J, WATANABE S, LI JH, et al.Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2[J].Hypertension, 2003, 41(6):1287-1293. doi: 10.1161/01.HYP.0000072820.07472.3B [22] NAKAGAWA T, MAZZALI M, KANG DH, et al.Hyperuricemia causes glomerular hypertrophy in the rat[J].Am J Nephrol, 2003, 23(1):2-7. doi: 10.1159/000066303 [23] FEIG DI, KANG DH, NAKAGAWA T, et al.Uric acid and hypertension[J].Curr Hypertens Rep, 2006, 8(2):111-115. doi: 10.1007/s11906-006-0005-z [24] HUANG Y, LI YL, HUANG H, et al.Effects of hyperuricemia on renal function of renal transplant recipients:a systematic review and Meta-analysis of cohort studies[J].PLoS One, 2012, 7(6):e39457.DOI: 10.1371/journal.pone.0039457. [25] CHOI JY, KWON OJ.The association between serum uric acid levels at 3 months after renal transplantation and the graft outcome in living donor renal transplantation[J].Transplant Proc, 2013, 45(4):1548-1552.DOI: 10.1016/j.transproceed.2012.10.062. [26] WENG SC, SHU KH, TARNG DC, et al.Uric acid is highly associated with kidney allograft survival in a timevarying analysis[J].Transplant Proc, 2014, 46(2):505- 510.DOI: 10.1016/j.transproceed.2013.09.038. [27] MIN SI, YUN IJ, KANG JM, et al.Moderate-to-severe early-onset hyperuricaemia:a prognostic marker of longterm kidney transplant outcome[J].Nephrol Dial Transplant, 2009, 24(8):2584-2590.DOI: 10.1093/ndt/gfp192. [28] 中华医学会内分泌学分会.高尿酸血症和痛风治疗的中国专家共识[J].中华内分泌代谢杂志, 2013, 29(11):913- 920.DOI: 10.3760/cma.j.issn.1000-6699.2013.11.001.Branch of Endocrinology of Chinese Medical Association.Chinese experts consensus on treatment of hyperuricemia and gout[J].Chin J Endocrinol Metabol, 2013, 29(11):913- 920.DOI: 10.3760/cma.j.issn.1000-6699.2013.11.001. [29] 高尿酸血症相关疾病诊疗多学科共识专家组.中国高尿酸血症相关疾病诊疗多学科专家共识[J].中华内科杂志, 2017, 56(3):235-248.DOI: 10.3760/cma.j.issn.0578-1426.2017.03.021.Expert Group of Multi-Disciplinary Consensus on the Diagnosis and Treatment of Hyperuricemia and its Related Diseases.Chinese multi-disciplinary consensus on the diagnosis and treatment of hyperuricemia and its related diseases[J].Chin J Intern Med, 2017, 56(3):235-248.DOI: 10.3760/cma.j.issn.0578-1426.2017.03.021. [30] GOICOECHEA M, DE VINUESA SG, VERDALLES U, et al.Effect of allopurinol in chronic kidney disease progression and cardiovascular risk[J].Clin J Am Soc Nephrol, 2010, 5(8):1388-1393.DOI: 10.2215/CJN.01580210. [31] BECKER MA, SCHUMACHER HR JR, WORTMANN RL, et al.Febuxostat compared with allopurinol in patients with hyperuricemia and gout[J].N Engl J Med, 2005, 353(23):2450-2461. doi: 10.1056/NEJMoa050373 [32] ENOMOTO A, KIMURA H, CHAIROUNGDUA A, et al.Molecular identification of a renal urate anion exchanger that regulates blood urate levels[J].Nature, 2002, 417(6887):447-452. doi: 10.1038/nature742 [33] TALAAT KM, EL-SHEIKH AR.The effect of mild hyperuricemia on urinary transforming growth factor beta and the progression of chronic kidney disease[J].Am J Nephrol, 2007, 27(5):435-440. doi: 10.1159/000105142 [34] JOHNSON RJ, KANG DH, FEIG D, et al.Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease?[J].Hypertension, 2003, 41(6):1183-1190. doi: 10.1161/01.HYP.0000069700.62727.C5 [35] SÁNCHEZ-LOZADA LG, NAKAGAWA T, KANG DH, et al.Hormonal and cytokine effects of uric acid[J].Curr Opin Nephrol Hypertens, 2006, 15(1):30-33. doi: 10.1097/01.mnh.0000199010.33929.7f
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