Uric Acid Metabolism and the Kidney

Hyperuricemia and gout are common in CKD patients. This relationship has been noted since the 1800s. Over the years there has been great controversy over the biologic significance of hyperuricemia, with some individuals arguing it is a major cause of CKD, and others viewing the rise in S[UA] as strictly an epiphenomenon. During the last 10 to 15 years, interest in uric acid has reawakened with the realization that an elevated S[UA] can predict the development of CKD and by experimental studies that document a causal role for uric acid in both the development and progression of CKD. Today there is great interest in the potential that uric acid may represent a remediable risk factor for CKD. We provide an update on uric acid and the kidney, focusing both on uric acid metabolism and a critical evaluation of the current evidence base for uric acid as a risk factor for CKD.