scholarly journals Tophaceous Gout and Renal Insufficiency: A New Solution for an Old Therapeutic Dilemma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Anne-Kathrin Tausche ◽  
Carsten Wunderlich ◽  
Martin Aringer
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Life Expectancy ◽  
Renal Impairment ◽  
Gouty Arthritis ◽  
Serum Urate ◽  
Oxidase Inhibitor ◽  
The Novel ◽  
Tophaceous Gout ◽  
Rapid Control

The prevalence of gout is increasing with increased life expectancy. Approximately half of the patients with gout have some degree of renal impairment. If both conditions persistently coexist, and in severe tophaceous gout, in particular, treatment has been difficult. We here report on the case of an 87-year-old woman, who had been suffering from recurrent gouty arthritis over 4 years. Monthly polyarthritis attacks were accompanied by subcutaneous tophi. Serum uric acid levels were constantly above 600 μmol/L (10 mg/dL). Allopurinol was no option because of intolerance, while benzbromarone was ineffective because of renal impairment. Therefore, the novel xanthin oxidase inhibitor febuxostat was started, achieving rapid control of serum urate levels (<360 μmol/L). After initial worsening of inflammation in the first weeks, gouty attacks stopped and all tophi resolved within the following 10 months. Renal function remained stable.

scholarly journals Efficacy and safety of urate-lowering therapy in people with kidney impairment: a GCAN-initiated literature review

2021 ◽  
Author(s):  
Hamish Farquhar ◽  
Ana B Vargas-Santos ◽  
Huai Leng Pisaniello ◽  
Mark Fisher ◽  
Catherine Hill ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Case Reports ◽  
Serum Urate ◽  
Cochrane Library ◽  
Future Studies ◽  
Kidney Impairment ◽  
The Cochrane Library ◽  
Study Designs ◽  
Different Levels

Abstract Objectives To evaluate the efficacy, defined as achieving target serum urate &lt;6.0 mg/dl, and safety of urate-lowering therapies (ULT) for people with gout and CKD stages 3–5. Methods PubMed, The Cochrane Library, and EMBASE, were searched from 1 January 1959 to 31 January 2018 for studies that enrolled people with gout, who had an estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) of &lt; 60 mL/min, and exposure to allopurinol, febuxostat, probenecid, benzbromarone, lesinurad or pegloticase. All study designs other than case reports were included, except for people on dialysis, for which we did include case reports. Results There were 36 reports with an analysis of efficacy and/or safety based upon renal function – allopurinol (n = 12), febuxostat (n = 10), probenecid (n = 3), benzbromarone (n = 5), lesinurad (n = 5), and pegloticase (n = 1). There were 108 reports that involved people with gout and renal impairment but did not contain any analysis on efficacy and/or safety based upon renal function – allopurinol (n = 84), febuxostat (n = 14), benzbromarone (n = 1), lesinurad (n = 3), and pegloticase (n = 6). Most studies excluded people with more severe degrees of renal impairment (eGFR or CrCl of &lt; 30mL/min). For allopurinol in particular, there was significant variability in the dose of drug used, and efficacy in terms of urate lowering, across all levels of renal impairment. Conclusion There is a lack of evidence regarding efficacy and/or safety of currently used ULT according to different levels of renal function. Future studies should include patients with CKD and should report study outcomes stratified by renal function.

P0234LOW URINARY CITRATE LEVELS ARE NOT SPECIFIC OF AUTOSOMAL POLYCYSTIC KIDNEY DISEASE (ADPKD) AND ARE PRESENT WHEN RENAL FUNCTION IS IMPAIRED IN ALL NEPHROPATIES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Francisco-Jose Borrego-Utiel ◽  
Enoc Merino Garcia ◽  
Isidoro Herrera ◽  
Clara Moriana Dominguez ◽  
Victoria Camacho Reina ◽  
...  
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Polycystic Kidney Disease ◽  
Normal Renal Function ◽  
Serum Bicarbonate ◽  
Polycystic Kidney ◽  
Glomerular Diseases ◽  
Urinary Citrate

Abstract Background and Aims In polycystic kidney disease (PKD) it is frequently found a reduction in urinary citrate that is related with degree of renal impairment but it is unknown if this alteration is specific or if it is also present in other nephropathies. Recently it has been suggested that urinary citrate could be a marker of covert metabolic acidosis and reflects acid retention in chronic kidney disease (CKD). Our aim was to compare urinary citrate in PKD with other renal diseases and to show its relation with serum bicarbonate and excretion of uric acid and calcium. Method We determined citrate, calcium and uric acid in 24-hour urine in patients with PKD and with other nephropathies with varied degree of renal impairment followed in a outpatient clinic of nephrology. Results We included 291 patients, 119 with glomerular diseases, 116 with PKD, 21 with other nephropathies, and 35 patients with normal renal function. Urinary citrate was higher in women (Females 309±251 mg/gCr vs. males 181±145 mg/gCr, p&lt;0.001) and in patients with normal renal function (normal 380±210 mg/gCr; PKD 203±166 mg/gCr; glomerular 279±282 mg/gCr; p&lt;0,001). PKD patients showed similar values of urinary citrate to patients with glomerular diseases and with other nephropathies. We observed a progressive reduction in urinary citrate parallel to degree of renal impairment, in a comparable way among patients with PKD and glomerular diseases. We did not observe a relationship between urinary citrate and serum bicarbonate levels. Calcium and uric acid elimination in ADPKD patients was similar to other nephropathies and lower to patients with normal renal function. However, serum uric acid was significantly higher in glomerular patients than other nephropathies after adjust with glomerular filtration rate and sex. Conclusion Hypocitraturia is not specific of PKD but it is also present in all nephropathies. Urinary citrate are related to degree of renal impairment and it is not related with serum bicarbonate. We think that it could be interesting to study urinary citrate as a marker of renal function and its role as prognostic factor of renal deterioration.

scholarly journals Relationship between severity of hypertension and renal impairment in preeclampsia

2018 ◽  
Vol 11 (3) ◽  
pp. 213
Author(s):  
Khairun Nahar ◽  
Ferdousi Islam ◽  
Naila Atik Khan
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Uric Acid ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Preeclamptic Patient ◽  
Blood Pressures ◽  
Mild Preeclampsia ◽  
The Mean ◽  
The Relationship

<p class="Abstract">The aim of this study was to determine the relationship between the severity of hypertension and renal impairment in preeclampsia. This study was conducted on 92 diagnosed cases of mild (n=42) and severe (n=50) preeclampsia patients from August 2010 to July 2011. All the patients were almost identical in terms of age and socioeconomic status. The results of the study showed that the mean serum creatinine and uric acid levels were significantly high in severe preeclampsia patient compared to mild preeclampsia and both systolic and diastolic blood pressures had the positive and significant effects on the serum creatinine and uric acid levels. In conclusion, impairment of renal function has the positive and significant relationship with the severity of blood pressure in the preeclamptic patient.</p>

Increased Potency and Decreased Elimination of Lamifiban, a GPIIb-IIIa Antagonist, in Patients with Severe Renal Dysfunction

1998 ◽  
Vol 79 (06) ◽  
pp. 1119-1125 ◽  
Author(s):  
Knut Nordal ◽  
Karsten Midtvedt ◽  
Timothy Goggin ◽  
Frank Brosstad ◽  
Gustav Lehne
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Ex Vivo ◽  
Severe Renal Impairment ◽  
Thrombus Formation ◽  
Drug Dosage ◽  
The Novel ◽  
Platelet Membrane Receptor ◽  
Group 3 ◽  
Group 2

SummaryActivation of the platelet membrane receptor glycoprotein (GP) IIb-IIIa is essential for thrombus formation. The novel nonpeptide GPIIb-IIIa antagonist, lamifiban, represents a promising approach for antiplatelet therapy in patients with cardiovascular disease. Since renal impairment frequently occurs in these patients, we designed a phase I study to assess the tolerability, pharmacodynamics and pharmacokinetics of lamifiban in patients with renal impairment. Four healthy volunteers (Group 1) with creatinine clearance (CLCR) >75 ml/min, eight patients (Group 2) with mild to moderately impaired renal function (CLCR 30-74 ml/min) and eight patients (Group 3) with severe renal impairment (CLCR 10-29 ml/min) were studied. They received stepwise increased doses of lamifiban intravenously (IV). There was a linear relationship between the systemic clearance of the drug and renal function (R2 = 0.86). The mean plasma concentration required for half-maximal inhibition of thrombin-receptor agonist peptide (TRAP) induced platelet aggregation (EC50) ex vivo was 21, 28 and 11 ng/ml in Groups 1, 2 and 3. The patients in Group 3 were sensitized to the anti-platelet effect allowing an 18-fold dosage reduction without compromising the pharmacodynamics. In conclusion, the decreased clearance of lamifiban may act in concert with increased potency of the drug in patients with severe renal impairment, and the drug dosage should be reduced accordingly.

Principles of gout management

2016 ◽  
Author(s):  
Pascal Richette
Keyword(s):  
Xanthine Oxidase ◽  
Interleukin 1 ◽  
Serum Urate ◽  
Oxidase Inhibitor ◽  
Tophaceous Gout ◽  
Xanthine Oxidase Inhibitor ◽  
Xanthine Oxidase Inhibitors ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
General Goals

The general goals of gout therapy are to manage acute flares and to prevent recurrences and prevent or reverse the complications of urate deposition by lowering urate levels. The choice of drug should be made on the basis of the patient’s co-morbidities, other medications, and side effect profile. Treatment of flares can be achieved with non-steroidal anti-inflammatory drugs, colchicine, or corticosteroids (systemic or intra-articular). Interleukin-1 blockers could become an alternative in patients contraindicated for traditional anti-inflammatory agents. Lowering of urate levels below monosodium urate (MSU) saturation point with both a non-pharmacological and pharmacological approach allows to dissolve MSU crystals and to cure gout. Serum urate (SUA) levels should be maintained below 6 mg/dL (360 μ‎mol/L) or below 5 mg/dL (300 μ‎mol/L) in patients with severe gout to facilitate faster dissolution of crystals. Urate-lowering therapy (ULT) should be initiated close to the first diagnosis of gout. Allopurinol and febuxostat are the most widely used xanthine oxidase inhibitors to lower SUA levels. If the SUA target cannot be reached by these agents, uricosurics are indicated, either alone or in combination with a xanthine oxidase inhibitor. In patients with severe tophaceous gout in whom the SUA target cannot be reached with any other available drug, pegloticase is indicated. Since ULT initiation may trigger acute attacks of gout, prophylaxis with an anti-inflammatory agent is recommended, mostly with low-dose colchicine. Of note, patient education, appropriate lifestyle advice, and treatment of comorbidities are also important parts of the management of patients with gout.

Clinical Characteristics of and Relationship Between Metabolic Components and Renal Function Among Patients with Early-onset Juvenile Tophaceous Gout

2014 ◽  
Vol 41 (9) ◽  
pp. 1878-1883 ◽  
Author(s):  
Chuan-Chin Lu ◽  
Shyi-Kuen Wu ◽  
Han-Yu Chen ◽  
Wei-Sheng Chung ◽  
Meng-Chih Lee ◽  
...  
Keyword(s):  
Renal Function ◽  
Early Onset ◽  
Clinical Characteristics ◽  
Middle Age ◽  
Age Of Onset ◽  
Relevant Information ◽  
Serum Urate ◽  
Common Site ◽  
Tophaceous Gout ◽  
Impaired Liver

Objective.Age of onset of gout has recently decreased; however, patients with early-onset gout remain uncommon, and relevant information is scant. We hypothesized that these patients might exhibit differences in serum urates and other comorbidities compared with adult-onset patients.Methods.Early-onset gout patients (i.e., juveniles) with (n = 40) and without tophi (n = 47) were enrolled for study. Their clinical characteristics were compared with those of 353 patients with middle-age-onset tophaceous gout and 64 age-matched healthy participants.Results.Early-onset gout patients with tophi exhibited significantly higher body mass indices and serum urate levels and lower estimated glomerular filtration rates (eGFR) than did those without tophi. Early-onset gout patients with or without tophi demonstrated significantly abnormal lipid profiles and impaired liver or renal function compared with healthy patients. Serum urate levels and gout duration were identified as the principal determinants of tophi development. The presence of tophi might be crucial in decreasing eGFR, which is inversely related to tophi duration or gout duration. Unexpectedly, the most common site of initial gout attacks in early-onset tophaceous gout patients was the ankle, not the toe, which was the most common site in middle-age-onset tophaceous gout patients. The most common site of first tophi occurrence in early-onset patients was a finger, not a toe, which was the most common site in middle-age-onset patients.Conclusion.Early-onset tophaceous gout patients are more likely to exhibit comorbidities and renal dysfunction than middle-age-onset patients and exhibit distinct first sites of gout attack and tophi occurrence patterns.

scholarly journals A REVIEW ON THE EFFECT OF FEBUXOSTAT IN CHRONIC KIDNEY PATIENTS, IT’S SIGNIFICANCE IN eGFR, URIC ACID AND ALBUMINURIA.

2019 ◽  
Vol 7 (2) ◽  
Author(s):  
Jinsu Deena Jose ◽  
Mathew George ◽  
Lincy Joseph
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Uric Acid ◽  
Kidney Disease ◽  
Uric Acid Level ◽  
Acid Level ◽  
Oxidase Inhibitor ◽  
Xanthine Oxidase Inhibitor ◽  
Irreversible Reduction ◽  
Risk Of Progression

Chronic kidney disease is defined as the abnormality of the kidney structure or function for≥ 3 months and is associated with an irreversible reduction of the excretory and the endocrine functions of the kidney. An important risk factor for the development and progression of CKD is hyperuricemia. Hyperuricemia can occur as a result of the increased production or the reduced secretion of uric acid. Increased uric acid level is significantly associated with a greater decline in renal function and there is a higher risk of progression into kidney failure. Febuxostat is a nonpurine xanthine oxidase inhibitor for the treatment of hyperuricemia in patients with chronic kidney disease. It reduces serum uric acid concentrations by blocking the transformation of hypoxanthine to xanthine and xanthine to uric acid. Febuxostat is mainly metabolized in the liver and excreted through both urine and feces. Renal adjustment is also not required in CKD patients with mild to moderately reduced eGFR as it is metabolized mainly by glucuronidation and oxidation in the liver and well excreted by both urinary and fecal routes. Recent studies show that, in addition to lowering the uric acid level, febuxostat preserves the eGFR. Keywords:  Chronic kidney disease, hyperuricemia, febuxostat, eGFR

scholarly journals Experience of arthroscopic surgery in tophaceous gout: indications, results and complications

2021 ◽  
Vol 27 (1) ◽  
pp. 55-58
Author(s):  
W. Tan ◽  
◽  
J. Chen ◽  
R. Ran ◽  
W. Zheng ◽  
...  
Keyword(s):  
Uric Acid ◽  
Arthroscopic Surgery ◽  
Blood Lead ◽  
Serum Urate ◽  
Functional Improvement ◽  
Tophaceous Gout ◽  
Younger Patients ◽  
Daily Work ◽  
Lowering Therapy ◽  
Reduction Of Pain

Background Gout, lasting 5 years or more, and high uncontrollable levels of uric acid in blood lead to the formation of tophi – gouty stones containing the UA crystals surrounded with connective tissue. As the result of tophi formation in the joint area patients felt extreme discomfort and quite often completely lose ability to work. Objectives To define indications for tophaceous gout surgery in the Chengdu Rheumatism Hospital, evaluate surgical results and complications, as well as the effectiveness of a new surgery equipment. Materials and methods The indications and results of tophaceous gout surgery were investigated in 63 male gout patients of Chengdu Rheumatism hospital in 2019-2020. A retrospective analysis was carried out on the basis of medical records for all patients who were prescribed with urate lowering therapy and underwent arthroscopic intervention or complex surgical intervention combining arthroscopic shaving with open tophectomy procedure. Results The most common lesion site was foot joints: toes (49.41 %), ankle (39.68 %) and knee (34.92 %), with restricted mobility in the mentioned joints. Among common complaints were inability to perform daily routines due to enlarged joints (inability to wear shoes), joints’ dysfunction and pain. Younger patients (aged 20–44) had significantly higher levels of uric acid in serum before treatment. In most cases, indications for surgery for this group of patients were pain and discomfort in joints, inability to perform daily work. After accessing pain levels, 38.46 % of younger patients reported pain leveled 6 or higher on VAS score, which was more often, compared to patients aged 45–55 (26.92 %) and older than 55 (10.0 %). After surgery and following urate lowering therapy all patients noted functional improvement and reduction of pain. Decrease in serum urate levels were reported in 96.83 % of patients. Conclusion The results of surgical treatment for functional impairment of the joint (inability to perform daily work due to restricted range of motions) and massive joint transformation (inability to wear shoes/clothes) in gout patients are positive, with all patients reporting functional improvement and reduction of pain, and the risk of complications is low. In addition to urate lowering therapy we cautiously recommend performing arthroscopic shaving even in younger gout patients consistent with aforementioned indications.

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