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Management of gout in the patient with renal disease 

Management of gout in the patient with renal disease
Chapter:
Management of gout in the patient with renal disease
Author(s):

Philip Courtney

and Michael Doherty

DOI:
10.1093/med/9780199579655.003.0162
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date: 05 August 2020

1. Gout is common, and increasing in prevalence in part due to the increasing frequency of end-stage renal disease.

2. Renal disease can cause chronic gross elevation of SUA above the saturation point for MSU crystal formation – the prerequisite for gout.

3. Other risk factors for gout include genetic predisposition, age, male gender, obesity, diet/lifestyle and OA.

4. Renal disease often associates with atypical clinical presentations of gout and difficulties in management due to increased toxicity or contraindication of drugs that are recommended.

5. Education, information access and lifestyle advice are important in patients with renal disease and gout.

6. In patients with renal disease, the acute mono-articular attack is best managed by local ice-packs together with aspiration and injection of intra-articular corticosteroid – this also allows confirmation of the diagnosis.

7. Polyarticular attacks of gout in renal patients can be treated with a short course of systemic corticosteroids.

8. The aim of lifestyle advice and ULT is to reduce the SUA below the saturation point for MSU crystal formation – the therapeutic target is to bring the SUA well below 360 µmol/l (6 mg/dl).

9. Allopurinol can be used at adjusted, lower doses in patients with renal disease but the therapeutic target may not always be reached.

10. Febuxostat is a new alternative to consider for patients with renal disease who are intolerant of, or unsuitable for, allopurinol.

11. NSAIDs, colchicine, sulphinpyrazone and probenecid are contraindicated in patients with severe renal disease; however, the uricosuric benzbromarone can be an effective ULT in patients with mild-moderate renal impairment.

12. Biological therapies that block IL-1β‎ have been shown to be very effective in the treatment of acute attacks and may reduce the frequency of acute gout.

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