nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2024-28-2-104-110TNHSRYnefr-2322Research ArticleПРОГРАММА НЕПРЕРЫВНОГО ПОСЛЕДИПЛОМНОГО ОБРАЗОВАНИЯ ПО НЕФРОЛОГИИPROGRAM ON CONTINUOUS POSTGRADUATE EDUCATION ON NEPHROLOGYИшемический инсульт: фокус на гиперурикемиюIschemic stroke: focus on hyperuricemiahttps://orcid.org/0000-0003-0632-6653ЮсуповФ. А.YusupovF. A.

Проф. Юсупов Фуркат Абдулахатович, д-р мед. наук, зав. кафедрой, член правления Общества специалистов по хронической болезни почек

714000, г. Ош, ул. Ленина, д. 331

Prof. Yusupov Furkat Abdulakhatovich, MD, PhD, DMedSci, Head, member of the Board of the Society of Specialists in Chronic Kidney Disease of Kyrgyzstan

331 Lenin Street, Osh, 714000

furcat_y@mail.ruhttps://orcid.org/0000-0002-4179-9205ЮлдашевА. А.YuldashevA. A.

Аспирант Юлдашев Акмал Акбарович 

714000, г. Ош, ул. Ленина, д. 331

Postgraduate student Yuldashev Akmal Akbarovich, Head, member of the Board of the Society of Specialists in Chronic Kidney Disease of Kyrgyzstan

331 Lenin Street, Osh, 714000

akmal.yuldashev.2017@list.ruКафедра неврологии, психиатрии и нейрохирургии медицинского факультета, Ошский государственный университетКыргызстанOsh State University, Medical Faculty, Department of Neurology, Psychiatry and NeurosurgeryKyrgyzstan202415072024282104110Copyright © Юсупов Ф.А., Юлдашев А.А., 20242024Юсупов Ф.А., Юлдашев А.А.Yusupov F.A., Yuldashev A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/2322

Мочевая кислота — слабая органическая кислота с молекулярной массой 168 г/моль. Большая часть мочевой кислоты при нормальном рН крови циркулирует в виде уратов, отрицательно заряженных слабых солей, полученных из мочевой кислоты. Являясь конечным продуктом процесса катаболизма пуринов, мочевая кислота выводится из организма человека с мочой. Гиперурикемия может возникать из-за снижения экскреции, увеличения продукции или комбинации обоих механизмов. За последние десятилетия в нескольких исследованиях среди взрослого населения была предпринята попытка установить корреляцию между риском развития инсульта и концентрацией мочевой кислоты в сыворотке крови, а также то, как эти уровни влияют на неврологический исход пациента после инсульта. Наш обзор посвящен изучению механизмов нормального метаболизма пуринов, нарушения пуринового обмена и патогенетические механизмы развития ишемического инсульта при гиперурикемии.

Uric acid is a weak organic acid with a molecular weight of 168.112 g/mol. Most uric acid at normal blood pH circulates as urates, negatively charged weak salts derived from uric acid. Being the end product of the process of purine catabolism, uric acid is excreted from the human body in urine until kidney function is impaired. Hyperuricemia may occur due to decreased excretion, increased production, or a combination of both mechanisms. Over the past decades, several studies in the adult population have attempted to establish the correlation between the risk of stroke and serum uric acid concentrations, and how these levels influence the patient's neurological outcome after stroke. Our review is devoted to the study of the mechanisms of normal purine metabolism, disorders of purine metabolism and pathogenetic mechanisms of the development of ischemic stroke in hyperuricemia.

мочевая кислотагиперурикемияишемический инсультпатогенезатеросклерозхроническая болезнь почектерапияuric acidhyperuricemiaischemic strokepathogenesisatherosclerosischronic kidney diseasetherapyReferencesVirani SS, Alonso A, Benjamin EJ et al. Heart disease and stroke statistics–2020 update: a report from the American Heart Association. Circulation 2020;141:0–596Virani SS, Alonso A, Benjamin EJ et al. Heart disease and stroke statistics–2020 update: a report from the American Heart Association. Circulation 2020;141:0–596Maida CD, Norrito RL, Daidone M, Tuttolomondo A, Pinto A. Neuroinflammatory mechanisms in ischemic stroke: focus on cardioembolic stroke, background, and therapeutic approaches. Int J Mol Sci 2020;21:6454Maida CD, Norrito RL, Daidone M, Tuttolomondo A, Pinto A. Neuroinflammatory mechanisms in ischemic stroke: focus on cardioembolic stroke, background, and therapeutic approaches. Int J Mol Sci 2020;21:6454Hyperuricemia (high URIC ACID) [ Aug; 2021]; https://chemocare.com/chemotherapy/side-effects/hyperuricemia-highuric-acid.aspx 2021Hyperuricemia (high URIC ACID) [ Aug; 2021]; https://chemocare.com/chemotherapy/side-effects/hyperuricemia-highuric-acid.aspx 2021Irfan M, Jawaid W, Hashmat O et al. Association between hyperuricemia and acute ischemic stroke in patients at a tertiary care hospital. Cureus 2020;12:0Irfan M, Jawaid W, Hashmat O et al. Association between hyperuricemia and acute ischemic stroke in patients at a tertiary care hospital. Cureus 2020;12:0Li L, Zhang Y, Zeng C. Update on the epidemiology, genetics, and therapeutic options of hyperuricemia. Am J Transl Res 2020;12:3167–3181Li L, Zhang Y, Zeng C. Update on the epidemiology, genetics, and therapeutic options of hyperuricemia. Am J Transl Res 2020;12:3167–3181Kang DH, Ha SK. Uric acid puzzle: dual role as anti-oxidant and pro-oxidant. Electrolyte Blood Press 2014;12:1–6Kang DH, Ha SK. Uric acid puzzle: dual role as anti-oxidant and pro-oxidant. Electrolyte Blood Press 2014;12:1–6Li L, Zhang Y, Zeng C. Update on the epidemiology, genetics, and therapeutic options of hyperuricemia. Am J Transl Res 2020 Jul 15;12(7):3167-3181Li L, Zhang Y, Zeng C. Update on the epidemiology, genetics, and therapeutic options of hyperuricemia. Am J Transl Res 2020 Jul 15;12(7):3167-3181Singh G, Lingala B, Mithal A. Gout and hyperuricaemia in the USA: prevalence and trends. Rheumatology (Oxford) 2019 Dec 1;58(12):2177–2180. doi: 10.1093/rheumatology/kez196Singh G, Lingala B, Mithal A. Gout and hyperuricaemia in the USA: prevalence and trends. Rheumatology (Oxford) 2019 Dec 1;58(12):2177–2180. doi: 10.1093/rheumatology/kez196Roman YM. The Daniel K. Inouye College of Pharmacy Scripts: Perspectives on the Epidemiology of Gout and Hyperuricemia. Hawaii J Med Public Health 2019 Feb;78(2):71–76Roman YM. The Daniel K. Inouye College of Pharmacy Scripts: Perspectives on the Epidemiology of Gout and Hyperuricemia. Hawaii J Med Public Health 2019 Feb;78(2):71–76Padda J, Khalid K, Padda S, Boddeti NL, Malhi BS, Nepal R, Cooper AC, Jean-Charles G. Hyperuricemia and Its Association With Ischemic Stroke. Cureus 2021 Sep 21;13(9):e18172. doi: 10.7759/cureus.18172Padda J, Khalid K, Padda S, Boddeti NL, Malhi BS, Nepal R, Cooper AC, Jean-Charles G. Hyperuricemia and Its Association With Ischemic Stroke. Cureus 2021 Sep 21;13(9):e18172. doi: 10.7759/cureus.18172Sautin YY, Johnson RJ. Uric acid: the oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids 2008;27:608–619Sautin YY, Johnson RJ. Uric acid: the oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids 2008;27:608–619Meshkani R, Zargari M, Larijani B. The relationship between uric acid and metabolic syndrome in normal glucose tolerance and normal fasting glucose subjects. Acta Diabetol 2011;48:79–88Meshkani R, Zargari M, Larijani B. The relationship between uric acid and metabolic syndrome in normal glucose tolerance and normal fasting glucose subjects. Acta Diabetol 2011;48:79–88Seet RCS, Kasiman K, Gruber J et al. Is uric acid protective or deleterious in acute ischemic stroke? A prospective cohort study. Atherosclerosis 2010;209:215–219Seet RCS, Kasiman K, Gruber J et al. Is uric acid protective or deleterious in acute ischemic stroke? A prospective cohort study. Atherosclerosis 2010;209:215–219Zhou Y, Zhao M, Pu Z, Xu G, Li X. Relationship between oxidative stress and inflammation in hyperuricemia: analysis based on asymptomatic young patients with primary hyperuricemia. Medicine (Baltimore) 2018;97:0Zhou Y, Zhao M, Pu Z, Xu G, Li X. Relationship between oxidative stress and inflammation in hyperuricemia: analysis based on asymptomatic young patients with primary hyperuricemia. Medicine (Baltimore) 2018;97:0Maruhashi T, Hisatome I, Kihara Y, Higashi Y. Hyperuricemia and endothelial function: from molecular background to clinical perspectives. Atherosclerosis 2018;278:226–231Maruhashi T, Hisatome I, Kihara Y, Higashi Y. Hyperuricemia and endothelial function: from molecular background to clinical perspectives. Atherosclerosis 2018;278:226–231Falsetti L, Capeci W, Tarquinio N et al. Serum Uric Acid, Kidney Function and Acute Ischemic Stroke Outcomes in Elderly Patients: A Single-Cohort, Perspective Study. Neurol Int 2017 Mar 27;9(1):6920. doi: 10.4081/ni.2017.6920Falsetti L, Capeci W, Tarquinio N et al. Serum Uric Acid, Kidney Function and Acute Ischemic Stroke Outcomes in Elderly Patients: A Single-Cohort, Perspective Study. Neurol Int 2017 Mar 27;9(1):6920. doi: 10.4081/ni.2017.6920Prasad Sah OS, Qing YX. Associations between hyperuricemia and chronic kidney disease: a review. Nephrourol Mon 2015;7:3Prasad Sah OS, Qing YX. Associations between hyperuricemia and chronic kidney disease: a review. Nephrourol Mon 2015;7:3Lyngdoh T, Marques-Vidal P, Paccaud F et al. Elevated serum uric acid is associated with high circulating inflammatory cytokines in the population-based Colaus study. PLoS One 2011;6:19901Lyngdoh T, Marques-Vidal P, Paccaud F et al. Elevated serum uric acid is associated with high circulating inflammatory cytokines in the population-based Colaus study. PLoS One 2011;6:19901Ren H, Qu H, Zhang Y, Gu Y et al. Detection of monosodium urate depositions and atherosclerotic plaques in the cardiovascular system by dual-energy computed tomography. Heliyon 2024 Jan 17;10(2):e24548. doi: 10.1016/j.heliyon.2024.e24548Ren H, Qu H, Zhang Y, Gu Y et al. Detection of monosodium urate depositions and atherosclerotic plaques in the cardiovascular system by dual-energy computed tomography. Heliyon 2024 Jan 17;10(2):e24548. doi: 10.1016/j.heliyon.2024.e24548Kim SY, Guevara JP, Kim KM et al. Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum 2009 Jul 15;61(7):885–892. doi: 10.1002/art.24612Kim SY, Guevara JP, Kim KM et al. Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum 2009 Jul 15;61(7):885–892. doi: 10.1002/art.24612Gagliardi ACM, Miname MH, Santos RD. Uric acid: a marker of increased cardiovascular risk. Atherosclerosis 2009;202:11–17Gagliardi ACM, Miname MH, Santos RD. Uric acid: a marker of increased cardiovascular risk. Atherosclerosis 2009;202:11–17Chiquete E, Ruiz-Sandoval JL, Murillo-Bonilla LM et al. Serum uric acid and outcome after acute ischemic stroke: PREMIER study. Cerebrovasc Dis 2013;35:168-174Chiquete E, Ruiz-Sandoval JL, Murillo-Bonilla LM et al. Serum uric acid and outcome after acute ischemic stroke: PREMIER study. Cerebrovasc Dis 2013;35:168-174Chiquete E, Ruiz-Sandoval JL, Murillo-Bonilla LM et al. Serum uric acid and outcome after acute ischemic stroke: PREMIER study. Cerebrovasc Dis 2013;35:168-174Chiquete E, Ruiz-Sandoval JL, Murillo-Bonilla LM et al. Serum uric acid and outcome after acute ischemic stroke: PREMIER study. Cerebrovasc Dis 2013;35:168-174Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994;25:808-813Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994;25:808-813Cicero AFG, Rosticci M, Tocci G et al. Serum uric acid and other short-term predictors of electrocardiographic alterations in the Brisighella Heart Study cohort. Eur J Intern Med 2015;2015:3–7Cicero AFG, Rosticci M, Tocci G et al. Serum uric acid and other short-term predictors of electrocardiographic alterations in the Brisighella Heart Study cohort. Eur J Intern Med 2015;2015:3–7Haeusler KG, Laufs U, Endres M. Chronic heart failure and ischemic stroke. Stroke 2011;42:2977-2982Haeusler KG, Laufs U, Endres M. Chronic heart failure and ischemic stroke. Stroke 2011;42:2977-2982Wang Z, Lin Y, Liu Y et al. Serum uric acid levels and outcomes after acute ischemic stroke. Mol Neurobiol 2015; 53:1753-1759Wang Z, Lin Y, Liu Y et al. Serum uric acid levels and outcomes after acute ischemic stroke. Mol Neurobiol 2015; 53:1753-1759Soltani Z, Rasheed K, Kapusta DR, Reisin E. Potential role of uric acid in metabolic syndrome, hypertension, kidney injury, and cardiovascular diseases: is it time for reappraisal? Curr Hypertens Rep 2013;15:175–181Soltani Z, Rasheed K, Kapusta DR, Reisin E. Potential role of uric acid in metabolic syndrome, hypertension, kidney injury, and cardiovascular diseases: is it time for reappraisal? Curr Hypertens Rep 2013;15:175–181Johnson RJ, Sanchez Lozada LG, Lanaspa MA et al. Uric Acid and Chronic Kidney Disease: Still More to Do. Kidney Int Rep 2022 Dec 5;8(2):229–239. doi: 10.1016/j.ekir.2022.11.016Johnson RJ, Sanchez Lozada LG, Lanaspa MA et al. Uric Acid and Chronic Kidney Disease: Still More to Do. Kidney Int Rep 2022 Dec 5;8(2):229–239. doi: 10.1016/j.ekir.2022.11.016Yildiz BS, Ozkan E, Esin F et al. Does high serum uric acid level cause aspirin resistance? Blood Coagul Fibrinolysis 2016;27:412–418Yildiz BS, Ozkan E, Esin F et al. Does high serum uric acid level cause aspirin resistance? Blood Coagul Fibrinolysis 2016;27:412–418Pasina L, Brucato AL, Djade CD et al. Inappropriate prescription of allopurinol and febuxostat and risk of adverse events in the elderly: results from the REPOSI registry. Eur J Clin Pharmacol 2014;70:1495–1503Pasina L, Brucato AL, Djade CD et al. Inappropriate prescription of allopurinol and febuxostat and risk of adverse events in the elderly: results from the REPOSI registry. Eur J Clin Pharmacol 2014;70:1495–1503Brucato A, Cianci F, Carnovale C. Management of hyperuricemia in asymptomatic patients: A critical appraisal. Eur J Intern Med 2020 Apr;74:8–17. doi: 10.1016/j.ejim.2020.01.001Brucato A, Cianci F, Carnovale C. Management of hyperuricemia in asymptomatic patients: A critical appraisal. Eur J Intern Med 2020 Apr;74:8–17. doi: 10.1016/j.ejim.2020.01.001Dalbeth N, Choi HK, Joosten LAB et al. Gout. Nat Rev Dis Primers 2019 Sep 26;5(1):69. doi: 10.1038/s41572-019-0115-yDalbeth N, Choi HK, Joosten LAB et al. Gout. Nat Rev Dis Primers 2019 Sep 26;5(1):69. doi: 10.1038/s41572-019-0115-yDong Y, Zhao T, Ai W, Zalloum WA et al. Novel urate transporter 1 (URAT1) inhibitors: a review of recent patent literature (2016-2019). Expert Opin Ther Pat 2019 Nov;29(11):871–879. doi: 10.1080/13543776.2019.1676727Dong Y, Zhao T, Ai W, Zalloum WA et al. Novel urate transporter 1 (URAT1) inhibitors: a review of recent patent literature (2016-2019). Expert Opin Ther Pat 2019 Nov;29(11):871–879. doi: 10.1080/13543776.2019.1676727Shekelle PG, Newberry SJ, FitzGerald JD et al. Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2017 Jan 3;166(1):37–51. doi: 10.7326/M16-0461Shekelle PG, Newberry SJ, FitzGerald JD et al. Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2017 Jan 3;166(1):37–51. doi: 10.7326/M16-0461Battelli MG, Bortolotti M, Polito L, Bolognesi A. Metabolic syndrome and cancer risk: The role of xanthine oxidoreductase. Redox Biol 2019 Feb;21:101070. doi: 10.1016/j.redox.2018.101070Battelli MG, Bortolotti M, Polito L, Bolognesi A. Metabolic syndrome and cancer risk: The role of xanthine oxidoreductase. Redox Biol 2019 Feb;21:101070. doi: 10.1016/j.redox.2018.101070Lesinurad/Allopurinol (Duzallo) for Gout-Associated Hyperuricemia. JAMA 2018 Jan 9;319(2):188–189. doi: 10.1001/jama.2017.20189Lesinurad/Allopurinol (Duzallo) for Gout-Associated Hyperuricemia. JAMA 2018 Jan 9;319(2):188–189. doi: 10.1001/jama.2017.20189Becker MA, Schumacher HR Jr, Wortmann RL et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005 Dec 8;353(23):2450–2461. doi: 10.1056/NEJMoa050373Becker MA, Schumacher HR Jr, Wortmann RL et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005 Dec 8;353(23):2450–2461. doi: 10.1056/NEJMoa050373Strilchuk L, Fogacci F, Cicero AF. Safety and tolerability of available urate-lowering drugs: a critical review. Expert Opin Drug Saf 2019 Apr;18(4):261–271. doi: 10.1080/14740338.2019.1594771Strilchuk L, Fogacci F, Cicero AF. Safety and tolerability of available urate-lowering drugs: a critical review. Expert Opin Drug Saf 2019 Apr;18(4):261–271. doi: 10.1080/14740338.2019.1594771Pascart T, Richette P. Investigational drugs for hyperuricemia, an update on recent developments. Expert Opin Investig Drugs 2018 May;27(5):437–444. doi: 10.1080/13543784.2018.1471133Pascart T, Richette P. Investigational drugs for hyperuricemia, an update on recent developments. Expert Opin Investig Drugs 2018 May;27(5):437–444. doi: 10.1080/13543784.2018.1471133Coiffier B, Mounier N, Bologna S et al. Trial on Rasburicase Activity in Adult Lymphoma. Efficacy and safety of rasburicase (recombinant urate oxidase) for the prevention and treatment of hyperuricemia during induction chemotherapy of aggressive non-Hodgkin’s lymphoma: results of the GRAAL1 (Groupe d’Etude des Lymphomes de l’Adulte Trial on Rasburicase Activity in Adult Lymphoma) study. J Clin Oncol 2003 Dec 1;21(23):4402–4406. doi: 10.1200/JCO.2003.04.115Coiffier B, Mounier N, Bologna S et al. Trial on Rasburicase Activity in Adult Lymphoma. Efficacy and safety of rasburicase (recombinant urate oxidase) for the prevention and treatment of hyperuricemia during induction chemotherapy of aggressive non-Hodgkin’s lymphoma: results of the GRAAL1 (Groupe d’Etude des Lymphomes de l’Adulte Trial on Rasburicase Activity in Adult Lymphoma) study. J Clin Oncol 2003 Dec 1;21(23):4402–4406. doi: 10.1200/JCO.2003.04.115

The authors declare that there are no conflicts of interest present.