Perez-Ruiz F, Calabozo M, Herrero-Beites A M, García-Erauskin G, Pijoan J I
Rheumatology Section, Hospital de Cruces, Barakaldo, Spain.
Nephron. 2000 Nov;86(3):287-91. doi: 10.1159/000045783.
To evaluate the effect of nonsteroidal anti-inflammatory drug (NSAID) withdrawal on renal function in patients with chronic gout after proper control of hyperuricemia and gouty symptoms.
Patients with chronic gout, who regularly used NSAIDs to control gouty symptoms prior to urate-lowering therapy, were prospectively followed up in an observational study. Risk factors for renal function impairment were recorded, and the clearance of creatinine (Ccr) was initially measured while on colchinine therapy to prevent gouty bouts. Therapy with urate-lowering drugs was started in order to keep serum urate levels under 6.0 mg/dl (275 micromol/l), and the Ccr was monitored during the follow-up period. Final assessment of the renal function was made after 1 year free from gouty bouts and without NSAID therapy during this period.
87 patients completed a 1-year period of NSAID withdrawal. Low initial Ccr was related to age, hypertension, hypertriglyceridemia and the presence of previous renal diseases. After proper control of gout and NSAID withdrawal during 1 year, the mean Ccr significantly raised from 94 to 104 ml/min. The improvement was especially significant in patients whose initial Ccr was under 80 ml/min. Their mean Ccr rose from 60 to 78 ml/min, and 12 of 29 patients achieved normal Ccr at the end of the study. No risk factor correlated with improvement of the renal function.
Renal function impairment in patients with chronic gout is mainly related to vascular risk factors, but improvement of the renal function was observed after proper control of hyperuricemia and NSAID withdrawal. Optimal control of hyperuricemia and, therefore, of symptoms of gout should be especially considered in patients with vascular risk factors in order to avoid renal function loss due to NSAID use.
评估在高尿酸血症和痛风症状得到适当控制后，停用非甾体抗炎药（NSAID）对慢性痛风患者肾功能的影响。
在一项观察性研究中，对在降尿酸治疗前定期使用NSAIDs控制痛风症状的慢性痛风患者进行前瞻性随访。记录肾功能损害的危险因素，并在使用秋水仙碱预防痛风发作时，首次测量肌酐清除率（Ccr）。开始使用降尿酸药物以使血清尿酸水平保持在6.0mg/dl（275μmol/l）以下，并在随访期间监测Ccr。在无痛风发作且在此期间未使用NSAID治疗1年后，对肾功能进行最终评估。
87例患者完成了为期1年的NSAID撤药期。初始Ccr较低与年龄、高血压、高甘油三酯血症以及既往肾脏疾病的存在有关。在痛风得到适当控制且1年内停用NSAID后，平均Ccr从94显著提高到104ml/min。在初始Ccr低于80ml/min的患者中，改善尤为显著。他们的平均Ccr从60升至78ml/min，29例患者中有12例在研究结束时Ccr恢复正常。没有危险因素与肾功能改善相关。
慢性痛风患者的肾功能损害主要与血管危险因素有关，但在高尿酸血症得到适当控制且停用NSAID后，肾功能有所改善。对于有血管危险因素的患者，应特别考虑对高尿酸血症以及痛风症状进行最佳控制，以避免因使用NSAID导致肾功能丧失。
