Hyperuricemia: current insights into pathogenesis, association with chronic kidney disease, oxidative stress, and perspectives of antioxidant therapy

Hyperuricemia (HUr) is not only a consequence of impaired purine metabolism but also an independent risk factor for the development and progression of chronic kidney disease (CKD). This article provides a systematic review of the current pathophysiological mechanisms of renal tissue damage in HUr, particularly the activation of oxidative stress, inflammatory cascades, endothelial dysfunction, and fibrosis development. Special attention is given to uromodulin (Umod) as a biomarker of the tubular system and a potential mediator of nephropathological processes. The article also reviews current literature on the therapeutic potential of antioxidants, in particular glutathione and ubiquinone, in the context of pathogenetically targeted therapy for CKD associated with hyperuricemia. The review is based on sources published between 2021 and 2025 and does not include primary results from the authors’ own clinical observations. Conclusions: In the context of CKD, hyperuricemia requires a multifactorial diagnostic and therapeutic approach, taking into account the role of oxidative stress and the prospects of antioxidant therapy.