혈중 요산 농도가 IgA 신병증의 진행에 미치는 연구 = The Impact of Serum Uric Acid Level on the Progression ofIgA Nephropathy

국문 초록 (Abstract)

목 적 : 요산은 고혈압의 발병원인으로 거론되고 있으며 신질환에서 고혈압과 신 동맥 병변을 유발하여 신기능 악화에 관여하는 것으로 보고되고 있다. 본 연구에서는 IgA 신병증에서 가능한 교란 변수 효과를 배제하여 요산의 신기능 악화인자 역할을 조사하고 그 병리 기전으로 요산과 고혈압 및 신동맥 병변과의 관련성을 조사하였다.
방 법 : 신조직 검사에서 확진을 받은 서울대학교 병원의 IgA 신병증 환자 172명을 대상으로 하였다. 신기능 악화 기준은 추적 도중 혈청 크레아티닌이 신 조직 검사 당시 혈청 크레아티닌의 2배 이상 증가하는 경우로 정하였다. 고요산군은 정상인 혈청 요산 수치의 4사분위에 해당되는 요산 수치를 가진 환자군으로 정하였다.
결 과 : IgA 신병증에서 혈중 요산 수치는 간질 섬유화, 세뇨관 위축, 세동맥 경화의 존재와 관련이 있었고, 추적 전후 혈압의 변동과는 무관하였다. 고요산군은 다변량 분석에서 IgA 신병증의 신기능 악화에 대한 위험인자 이었다. 고혈압, 사구체 여과율, 병리 소견으로 세분하여 분석한 결과 고요산군은 고혈압 유무와 세동맥 경화 유무에 관련없이 신병증의 예후를 결정하는 독립적인 인자이었고, 사구체 여과율이 60 mL/min/1.73m2 이상인 환자군에서도 예후 인자로 분석되었다.
결 론 : IgA 신병증에서 고요산혈증은 신 동맥 병변과 신기능 악화와 관련이 있었다.

다국어 초록 (Multilingual Abstract)

Purpose: Many evidences about hyperuricemia as a risk factor to hypertension and renal progression in kidney diseases have been reported. We have analyzed the impact of uric acid on renal progression of IgA nephropathy while getting rid of possible confounding variables and revealed the possible pathophysiology of uric acid in terms of hypertension or renal vasculopathy provoked by uric acid.
Methods: We selected 172 patients with IgA nephropathy diagnosed by renal biopsy at Seoul National University Hospital. We adapted the criteria of renal progression as the final value of serum creatinine increased more then twice compared to the value at renal biopsy.
Results: Serum uric acid was correlated with the severity of interstitial fibrosis and tubular atrophy and the presence of artherosclerosis. The incidence of hypertension during follow-up period was not different between low uric acid group and high uric acid group. The high uric acid level was an independent risk factor to renal progression in IgA nephropathy with multivariate analysis regardless of the presence of hypertension or artherosclerosis of renal pathologic finding. The high uric acid level was also a risk factor to renal progression in patients with estimated GFR more than 60 mL/min/1.73m2.
Conclusion: Serum uric acid was related to the presence of artherosclerosis and the renal progression of IgA nephropathy.

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