Estiverne Christopher, Mount David B
Renal Division, Brigham and Women's Hospital, Boston, MA.
Renal Division, Brigham and Women's Hospital, Boston, MA; Renal Division, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
Semin Nephrol. 2020 Nov;40(6):600-613. doi: 10.1016/j.semnephrol.2020.12.007.
Gout, a debilitating inflammatory arthritis, currently affects more than 9 million Americans. Hyperuricemia, the laboratory abnormality associated with the development of gout, also occurs in a significant number of patients with chronic kidney disease (CKD), a condition that affects approximately 14% of the US population. Several recent studies have attempted to provide a definitive link between the presence of hyperuricemia and progression of CKD; however, the treatment of asymptomatic hyperuricemia in CKD is not supported by recent randomized controlled trials. The pharmacology of acute gout flares and urate lowering is complicated in patients who also have evidence of CKD, primarily because of an increased risk of medication toxicity. Recipients of kidney transplants are particularly at risk of debilitating gout and medication toxicity. We review the available data linking CKD, gout, and hyperuricemia, providing practice guidelines on managing gout in CKD patients and kidney transplant recipients. We advocate for much greater involvement of nephrologists in the management of gout in renal patients.
痛风是一种使人衰弱的炎性关节炎，目前影响着超过900万美国人。高尿酸血症是与痛风发展相关的实验室异常指标，在大量慢性肾脏病（CKD）患者中也有出现，慢性肾脏病影响着约14%的美国人口。最近的几项研究试图明确高尿酸血症的存在与慢性肾脏病进展之间的联系；然而，近期的随机对照试验并不支持对慢性肾脏病患者的无症状高尿酸血症进行治疗。在同时有慢性肾脏病证据的患者中，急性痛风发作和降低尿酸的药理学情况较为复杂，主要是因为药物毒性风险增加。肾移植受者尤其有患使人衰弱的痛风和药物毒性的风险。我们回顾了将慢性肾脏病、痛风和高尿酸血症联系起来的现有数据，提供了关于管理慢性肾脏病患者和肾移植受者痛风的实践指南。我们主张肾病科医生更多地参与到肾病患者痛风的管理中。
