I’ve collected various threads here that relate to gout with kidney disease. Because, as I said earlier, this is usually too complicated for an online forum. So, generally, I want to refer kidney-related questions back to the doctor.
Anyway, here is a 12 point guide why this is complicated. Also, individual gout patients with kidney disease will have their own added personal complications. So, feel free to discuss general aspects of gout with kidney disease. But please discuss personal medical issues with your doctor.
I’ve changed the wording of this 12-point list to try to make it more readable. It’s from chapter 30 of Rheumatology and The Kidney (Courtney, Philip, and Michael Doherty. “Management of gout in the patient with renal disease.” Rheumatology and the Kidney (2012): 415.):
- Gout is increasing in prevalence. In part due to the increasing frequency of end-stage kidney disease.
- Kidney disease can cause uric acid to rise to the point where crystals form.
- Other risk factors for gout include genetic predisposition, age, male gender, obesity, diet/lifestyle, and osteoarthritis.
- Kidney disease often links with unusual gout and difficulties in management. Usual gout drugs might be toxic or otherwise inappropriate.
- Education, information access, and lifestyle advice are important for gout patients with kidney disease.
- For kidney disease patients, the single-joint gout attack is best managed by local ice-packs. Together with joint fluid draw and injection of intra-articular corticosteroid. Also, joint fluid analysis allows confirmation of the diagnosis.
- Multi-joint gout attacks in kidney patients can be treated with a short course of systemic corticosteroids.
- Lifestyle advice and treatment should reduce uric acid well below 6 mg/dl (360 µmol/l).
- Allopurinol can be used at lower doses in patients with kidney disease. But the therapeutic target may not always be reached.
- Febuxostat (Uloric) is a new alternative to consider for patients with kidney disease who cannot take allopurinol.
- NSAIDs, colchicine, sulphinpyrazone, and probenecid are not suitable for patients with severe kidney disease. However, benzbromarone can be effective in patients with mild-moderate kidney disease.
- 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.