What I Wish I'd Known About Gout & Chronic Kidney Disease

Content

• Risk Factors
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• New Gout Treatment Guidelines Emphasize Genetic Risk, Need For Medications
• Rare Disease Database

Additional postbaseline characteristics are provided in eTable 2 in the Supplement. We conducted a time-stratified propensity score–matched cohort study in The Health Improvement Network , which is a general practitioner electronic medical records database representative of the UK general population. The institutional review board at Boston University Medical Campus and THIN Review Committee approved the study and written informed consent was waived because all data were deidentified.

When it comes to gout and kidneys, what’s good for one is good for the other. Gout is the most common form of arthritis, causing needle-like pain and swellling in the joints, most often in the big toe. In most people, gout comes and goes, but some people have chronic gout, in which the joints stay inflamed. If you have chronic gout, you have an increased risk of kidney disease, in which your kidneys gradually lose function. Doctors have been aware of this link between gout and kidney disease for decades, but the nature of the connection was a matter of debate.

Risk Factors

With the incompletely understood association between gout and kidney disease, it is reasonable to explore the possibility that activation of the innate immune system - common to both - may help explain this association. It is now clear that a similar involvement of the innate immune system occurs in many forms of acute and chronic kidney disease with accentuation of renal tubular injury and stimulation of tubulointerstitial fibrosis. The local and systemic activation of the innate immune system may help explain the close association of these conditions and provide a target for therapeutic interdiction. We performed a comprehensive search of PubMed and other major bibliographic databases on May 7, 2016 and identified no previous studies that have characterized the incidence of gout according to level of kidney function and sex. Moreover, there are conflicting results regarding whether individuals on dialysis have a higher risk of gout compared with individuals with more moderate declines in kidney function (12–14).

It is unclear whether medications that lower urate affect cardiovascular disease risks. This may be partly due to its association with insulin resistance and obesity, but some of the increased risk appears to be independent. Lesinurad reduces blood uric acid levels by preventing uric acid absorption in the kidneys.

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Vitamin C has been shown to be helpful with preventing gout flares. More recently, though, a review found that taking higher doses of vitamin C did not directly correlate with preventing or treating gout. Kidney stones are also found to be more common in diets high in sugar, especially sugary beverages and fructose. Whatever medication you are currently taking, it’s always very important to first discuss any changes with your primary care physician or nephrologist.

To ensure we were accurately capturing gout, in an additional analysis, we defined gout solely by evidence of dispensing of a medication typically used to treat gout . Background and objectives The risk of gout across CKD stages is not well described. As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Do uric acid crystals go away?

Stress may trigger a gout attack, and it can exacerbate symptoms of a gout attack. While it's impossible to completely eliminate all of your stress, there are a number of ways to help minimize it. If you're experiencing a gout attack, reducing your stress can also help you focus on things other than the pain.

Hyperuricemia does not always lead to symptoms or a diagnosis of gout. If high levels of uric acid are noted without symptoms, it may not need to be treated. It’s important to understand what they are, and what you can do with your diet to prevent both from occurring. Learn more in this article about what you can do for both gout and kidney stones. The database analysis was performed using electronic medical records from the South Central Veterans’ Affairs Health Care Network data warehouse. The health care network represents 10 medical centers and 40 community-based outpatient clinics.

Gout And Pseudogout

This more aggressive treatment is used without other drug therapy and can reduce uric acid levels significantly and quickly and eliminate the tophi, often within eight to nine months. In summary, when you start a uric acid-lowering drug, your provider should slowly raise the dose and keep checking your blood uric acid levels regularly. Once your uric acid level falls below a healthy 6.0 mg/dL, crystals tend to dissolve, and new deposits of crystals can be prevented. It is important to know your uric acid level, just as it is important to know your cholesterol or blood glucose levels. Talk to your doctor if you are experiencing sore joints or frequent urinary tract infections.

Patients with gout are at increased risk of chronic kidney disease and kidney failure, according to new University of Limerick , Ireland led research. When you have chronic kidney disease , your kidneys do not work as well as they should to filter wastes out of your body. Uric acid is a waste product that is naturally found in your blood. When you have kidney disease, your kidneys cannot filter out uric acid as well as they should.

What are the 4 stages of gout?

Drink plenty of water, milk and tart cherry juice. Drinking coffee seems to help as well. Be sure to talk with your doctor before making any dietary changes.

A meta-analysis demonstrated that hyperuricemia could increase the risk of CKD . Most patients with hyperuricemia also have metabolic diseases, which can easily result in CKD . Therefore, whether hyperuricemia is a marker or risk factor for CKD is still subject to debate. While guidelines for gout management include the use of urate lowering therapy, to date there is limited evidence to support the management of asymptomatic hyperuricemia. However, emerging data suggests that urate lowering therapy has potential protective effects on the kidneys. The connection with allopurinol and kidney function is more that the medication can accumulate in the body with kidney damage, not that the medication itself causes a decline in kidney function .

Humans and other primates are prone to hyperuricemia because we lack uricase . To lower uric acid levels, we must use xanthine oxidase inhibitors such as allopurinol and febuxostat, recombinant uricases such as rasburicase, and inhibitors of urate reabsorption such as probenecid. One way that gout may contribute to chronic kidney disease is through kidney stones.

Untreated kidney disease can ultimately lead to kidney failure, or loss of kidney function. The data were analyzed using Cox proportional hazards regression. You have much to gain by keeping your uric acid levels down if you have chronic gout. Not only will your pain and inflammation recede, but you may avoid kidney problems, and people with CKD may see improvement in their kidney function. Studies in the United Kingdom showed that uric acid reducers can cut kidney disease progression in half and reduce the incidence of heart attack or stroke by more than that.

Where A Donor Kidney Comes From

It is possible that our finding of the risk of CKD development being highest within 2 years of gout diagnosis reflects this. An important caveat is gout ascertainment based on GP-coded diagnoses alone, risking misclassification bias, although gout diagnoses have been validated in CPRD and have a positive predictive value of 90% . GP consultation rates during follow up were adjusted for in the statistical analysis but may not completely address this issue.