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Gouty nephropathy: Treatment, symptoms, advice and help

About gouty nephropathy

Gouty nephropathy is a disorder characterised by the high levels of uric acid in the urine, which leads to rapid worsening of the kidney function. It is problematic since the human body does not possess the enzyme ‘uricase’, which can convert the uric acid into more soluble compounds. This results in formation of excess uric acid in the body.

Three forms of kidney disease have been attributed as a result of excess uric acid: acute uric acid nephropathy, chronic urate nephropathy, and uric acid nephrolithiasis. The clinical features may vary in all these three forms of nephropathy.

Gouty nephropathy: Incidence, age and sex

The incidence rate of gouty nephropathy is not known. It is seen more frequently in men as compared to women with a ratio of 4:1.

Signs and symptoms of gouty nephropathy: Diagnosis

The chief sign and symptom includes decreased production of urine. Blood test generally reveals a rise in serum creatinine levels. In a random urine sample, the urine uric acid/creatinine ratio is greater than 1.

Causes and prevention of gouty nephropathy

Most cases of acute gouty nephropathy occur when one is being treated for leukaemia or lymphoma. It also has been seen in association with other malignancies, such as metastatic breast cancer, lung cancer, or disseminated adenocarcinoma.

Seizures and pregnancy-related pre-eclampsia or eclampsia may also have an association with gouty nephropathy. Moreover renal transplantation or longstanding use of a medication by the name of cyclosporine may also lead to gouty nephropathy. Prolonged accumulation of uric acid in the urine is the main cause of chronic urate nephropathy.

Acute diarrhoeal state may increase urinary uric acid output through excessive water loss and dehydration, thus leading to the formation of stones.

It is advisable to give allopurinol or rasburicase in high-risk individuals before treating them with cytotoxic drugs. This may help in preventing any renal stones in future.

Gouty nephropathy: Complications

Gouty nephropathy, if left untreated, may result in kidney failure. This is a serious condition which may be potentially life-threatening.

Gouty nephropathy: Treatment

Potent diuretics need to be given to increase the urine output, thereby preventing deposition of uric acid within the urinary system. Medications like sodium bicarbonate and/or acetazolamide can also be considered to increase uric acid solubility. Dialysis (preferably haemodialysis) is the last resort in the treatment cycle, if the above measures do not result in expected improvement.