Serum Uric Acid Levels and Kidney Transplant Outcomes: Cause, Consequence, or Confounded?

Uric acid is an end product of purine metabolism by the liver, intestines, and other tissues (including muscle and kidneys). It was first discovered in 1776 in a bladder calculus.1 The association of uric acid with human diseases beyond kidney stones was initially described in patients with gouty arthritis, but has since extended to other conditions such as hypertension, cardiovascular disease, cerebrovascular disease, metabolic syndrome, preeclampsia, and kidney disease.2 Several mechanisms have been proposed to explain the linkage between uric acid and various disease states, but central to these explanations has been uric acid's potential role in endothelial dysfunction (by nitric oxide depletion), vascular smooth muscle proliferation, inflammation, oxidative stress, and activation of the renin-angiotensin system.

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