Purpose of review: To assess the current data suggesting that uric acid-lowering therapy may be useful in the prevention or mitigation of chronic kidney disease (CKD). Recent findings: Eleven observational studies assessing the potential role of serum uric acid in the prevalence and progression of CKD have been published in the past 2 years. Seven suggest an association, whereas four do not. Recent experimental models and clinical trials have mechanistically linked serum uric acid and hypertension, an established risk factor for CKD. Summary: Elevated serum uric acid is a marker for decreased renal function, may have a mechanistic role in the incidence and progression of renal functional decline and likely has a causal role in hypertension and vascular disease. Clinical trials are needed to determine whether uric acid-lowering therapy will be effective in preventing CKD. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.