Monday, April 27, 2015

Gout May Predispose Patients to Chronic Kidney Disease (CKD) and Nephrolithiasis

Gout is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood. It may also present as tophi, kidney stones, or urate nephropathy. Once the acute attack subsides, levels of uric acid are usually lowered via lifestyle changes, and in those with frequent attacks, allopurinol or probenecid provides long-term prevention.

Investigators pooled results from 17 epidemiological studies of gout patients. Estimates of CKD (stage 3 and above) and nephrolithiasis among people with gout were 24% and 14%, respectively.

In addition, gout was linked with more than twice the odds of developing CKD and one and a half times the odds of ever developing nephrolithiasis. Few of the included studies were prospective, so the researchers couldn't assess timing.

According to the researchers, patients with gout should actively be screened for CKD and its related conditions. Currently, just 1 in 5 patients with acute gout are screened for CKD within a month of presentation.

There are several possible mechanisms by which gout could lead to CKD and kidney stones, they noted. Kidney damage may result from hypertension, diabetes, nonsteroidal anti-inflammatory drugs, and endothelial dysfunction from hyperuricemia. Or, persistent inflammation from gout may cause vascular damage.

Treatment with allopurinol was believed to interfere with kidney function, but a recent systematic review suggested that it actually may protect against CKD progression. Our email kidneyhospitalabroad@hotmail.com

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