Drugs Used For Flare Prophylaxis
Although the medications used for flare prophylaxis are the same as those used to treat flares, they are generally used at lower doses and for longer periods of time . A post hoc analysis of three phase III RCTs in people starting febuxostat who also received prophylaxis with colchicine included participants with an eGFR of < 30ml/min/1.73m2 but again the results were not stratified by renal function. Long-term use of colchicine in the general population has been associated with bone marrow suppression and neuromyotoxicity, but whether these effects are increased in those with gout and CKD is unknown. Whereas short-term courses of glucocorticoids can be considered to have an acceptable riskbenefit profile, long-term use of glucocorticoids for flare prophylaxis can be associated with an increased risk of glucocorticoid-related adverse events, particularly infections, as seen in other rheumatic diseases,. This risk could be particularly concerning in a population that is already at high risk of severe infections, such as those with CKD. Whether the gout flare rate when starting ULT is the same in those with CKD as in those without, and whether prophylaxis is always required, are unknown, although a recent study of incremental use of febuxostat suggested that prophylaxis might not be required when a dose-escalation approach is used.
How Can You Prevent Gout If You Have Kidney Disease
- Follow a healthy kidney-friendly diet. Reducing your sodium and protein intake can help you feel your best while maintaining a healthy weight. However, this doesnt mean you need to give up all the foods and drinks you love. Check out these kidney-friendly recipes for inspiration.
- Take your medications as prescribed. Certain medications used to treat gout are not safe for your kidneys. Make sure to talk to your doctor about what medications to take and how frequently.
- Monitor your weight. Obesity is a risk factor for gout. When coupled with kidney disease, it may increase your chances of having gout. Work with your care team to develop a plan for reaching and maintaining a healthy weight. Your care team can also help you monitor your weight and keep track of any changes.
- Maintain a healthy blood pressure. Lowering your blood pressure is important for protecting your kidneys and overall health. Your doctor can help you create a treatment plan to take control of your blood pressure.
- Maintain a healthy blood sugar level. Frequent or ongoing high blood sugar can cause damage to your nerves, blood vessels, and kidneys. To help reduce the risk of an attack of gout, it is important to keep your blood sugar levels balanced.
Foods And Drinks To Avoid When You Have Gout
Alcohol is a trigger for gout attacks. When you drink, your kidneys work to filter out alcohol instead of uric acid, leaving uric acid to build up in your body. Beer is especially bad for gout because it has purines.
Sugary drinks , sugary foods, and foods with high-fructose corn syrup should be limited because of their connection to gout. There is less evidence about why these foods and drinks increase the risk of gout, but some connection has been found.Foods that are high in purines should be completely avoided since they contribute to creating uric acid in your body. These include:
- Anchovies
Content courtesy of the National Institutes of Health .
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What Happens During A Uric Acid Test
A uric acid test can be done as a blood test or a urine test.
During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
For a uric acid urine test, you’ll need to collect all urine passed in a 24-hour period. This is called a 24-hour urine sample test. Your health care provider or a laboratory professional will give you a container to collect your urine and instructions on how to collect and store your samples. A 24-hour urine sample test generally includes the following steps:
- Empty your bladder in the morning and flush that urine away. Record the time.
- For the next 24 hours, save all your urine passed in the container provided.
- Store your urine container in the refrigerator or a cooler with ice.
- Return the sample container to your health provider’s office or the laboratory as instructed.
Kidney Disease And Gout
People who have kidney disease are generally more susceptible to abnormally high amounts of uric acid in their blood, or hyperuricemia. Because their kidneys are unable to remove adequate amounts of uric acid from the body, gout occurs. If a person has had a kidney transplant, they become more susceptible to gout as a result of medications taken to aid the assimilation of the kidney into the body. These medications tend to increase the amount of uric acid in the individual’s body and the person may develop gout, tophi and persistent arthritis as a result of medication.
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Gout Symptoms And Complications
Gout is not gout until symptoms occur. When they do, they usually come on suddenly and, at least initially, affect a single joint. Within hours, that joint becomes red, swollen, hot, and painful they’re called gout attacks for a reason. It’s easy to mistake a gout attack for a localized infection of a joint. The metatarsophalangeal joint at the base of the big toe is often the site of the first attack, but the knees, ankles, and joints between the many small bones that form the foot are also common sites. People who already have osteoarthritis the most common form of arthritis often experience their gout attacks in the joints of the finger
What Causes Kidney Malfunction
A major culprit of kidney problems is an acidic diet . A brand-new study sheds light on the renal problems that can be caused by a high-acid, meat-rich diet.
The study followed 1,500 people with kidney disease for a period of 14 years. Participants who ate a diet high in meat came very close to experiencing complete kidney failure, while those who ate more fruits and vegetables did not even come close to kidney failure. Researchers estimate that an acidic diet can make it three times more likely for your kidneys to fail.1
Says lead study author Dr. Tanushree Banejee,
Patients with chronic kidney disease may want to pay more attention to diet consumption of acid rich foods to reduce progression to kidney failuredialysis treatmentsmay be avoided by adopting a more healthy diet that is rich in fruits and vegetables.1
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Renal Handling Of Urate
Renal excretion of uric acid involves 4 pathways: filtration, reabsorption, secretion, and postsecretory reabsorption. Urate is freely filtered at the glomerulus. An active anion-exchange process in the early proximal convoluted tubule reabsorbs most of it. Most urinary uric acid appears to be derived from tubular secretion, possibly from the S2 segment of the proximal tubule. Overall, 98-100% of filtered urate is reabsorbed 6-10% is secreted, ultimately appearing in the final urine.
Several factors influence the renal handling of urate. Many medications can affect the renal transport of uric acid through effects of proximal tubular absorption and secretion. Extracellular volume expansion or contraction, respectively, enhances or reduces uric acid excretion through the paired movement of sodium. Consequently, in cases of extracellular compartment depletion, urate excretion is diminished.
Physiologically, the major factors that affect urate excretion are the tubular fluid pH, the tubular fluid flow rate, and renal blood flow. The first 2 factors primarily diminish uric acid and urate precipitation in the collecting ducts, while the third is important in urate secretion. In disorders such as sickle cell disease, hypertension, and eclampsia, hyperuricemia out of proportion with decreases in glomerular filtration result from decreased renal blood flow. Organic acids, such as lactic acid and ketoacids, also can impair the proximal secretion of uric acid.
How Gout Affects Your Kidney Disease Risk
Your risk for kidney disease jumps quite high when you suffer from gout: about 40 percent of gout patients also have chronic kidney disease. Moreover, the more advanced the kidney disease, the likelier you are to suffer from gout symptoms.
A Dangerous Cycle
Experts suspect that the relationship between kidney disease and gout is so pronounced because each condition feeds the other.
On the one hand, the kidneys excrete uric acid, and that uric acid can accumulate and crystallize, causing gout. However, hyperuricemia can also speed up the progression of kidney disease by overwhelming the waste-removing organs.
The result? A vicious cycle that puts your kidneys at great risk of damage, and eventually, failure.
The Source of the Trouble
As is the case with many chronic diseases, ongoing low-grade inflammation is likely the culprit behind the elevated risk of kidney, hyperuricemia and gout. In these diseases, inflammation is systemic that is, not necessarily limited to a specific area which creates a widespread problem that is difficult to control.
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So What Is The Cause Of This Condition
Well I am glad you asked essentially gout is the deposit of monosodium urate crystals in and around the joints, which are caused by increased levels of uric acid. Uric acid is formed when purines are broken down. Purines are found in certain foods such as meat, peas, and alcohol, and also occur naturally in our cells. High levels of uric acid cause inflammation and damage to joints and soft tissues. So gout can be either caused by the overproduction or under excretion of uric acid, such as in kidney disease. Gout can be a very common occurrence in those suffering from under functioning kidneys.
Here is a list of the major contributing factors, and risk factors, of gout:
- Kidney failure
- Bone fracture or surgical procedure
- Polynesian background
- High blood pressure
- Lead crystal glasses: Lead toxicity is a cause of gout . Leaded crystal decreases renal urate excretion.
How Can Kidney Disease Lead To Gout
Normal kidneys filter waste and excess fluids from the blood. However, kidney function declines when you have chronic kidney disease. The ability of the kidneys to remove excess uric acid effectively and efficiently is compromised.
Waste and minerals build up in the blood over time, worsening your kidney condition. Uric acid is a waste product found in the blood when purines are broken down in the digestive system. Most uric acid dissolves in the blood and passes through the kidneys. Uric acid leaves in the body through urine. Nevertheless, when uric acid remains in the body for too long, it can crystallize and cause gout.
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Control Gout And Protect Your Heart Health
Maintaining a healthy serum uric acid level of 6.0 mg/dL or below is important to reduce risk for gout and heart disease. Ask your doctor for a routine serum uric acid blood test to see if you have elevated uric acid. The doctor can also run tests to measure your blood pressure and check your cholesterol levels.
If your uric acid levels are high, your doctor may prescribe medications to keep uric acid levels low and reduce your risk for future gout flares. It is important to take these medications as prescribed and not to stop them without talking with the doctor. It is also important to tell your doctor about all other medications and supplements you are taking, as some may be raising your uric acid levels.
Other stepssuch as drinking plenty of water to flush the kidneys and help to remove uric acid from the bloodstream exercising and maintaining a healthy body weight and avoiding trigger foodsare also important for reducing risk.
To learn more about gout and heart health, . Additional information about heart health is available through the American Heart Association at heart.org.
Cherries And Foods With Vitamin C
Some foods like cherries and fruits and vegetables high in vitamin C have been shown to lower the level of uric acid in your blood, which can have a positive effect on gout. Some examples of foods high in vitamin C are:
- Oranges
- Bell peppers
- Pineapples
There is mixed evidence about whether cherries, and foods with high vitamin C can help prevent gout. Eating these foods will not treat gout the way that medicines can. In some cases, they may help improve your condition in some way.
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Why Do Gout Attacks Happen More At Night
Gout attacks happen more at night and in the early morning rather than during the day. You may have an attack start during your sleep. The reasons this happens are not entirely known, but some of the leading ideas are dehydration, lower body temperature, and changes in hormone levels during sleep.Talk to your doctor about ways to prevent gout attacks during your sleep.
Identification Of Research Areas
Data from the literature were thematically analysed by the leaders and fellows of each literature review team to identify general issues with the currently available data with regard to gout and gout studies in people with concomitant CKD as well as specific issues with individual medications.
The research areas and general requirements for studies identified were agreed on by the leaders and fellows of each literature review team and then circulated to all authors of this Consensus Statement. Agreement was reached by consensus of all authors via e-mail, and final approval was granted by the G-CAN Board. No effort was made to prioritize the research areas.
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Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
- Obesity, or a lot of extra weight.
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins
- Consume a significant amount of alcohol
- Are on water pills .
Does Having High Uric Acid Mean You Have Kidney Problems
As I understand it it could be either you make too much or kidneys eliminate too little. Doesnt necessarily mean kidney problems in either case.
Not treating high UA can cause kidney stones and complications however.
simplest is to have a doctor test your blood and urine. In my case that is what the cause of my gout. I was able to make some healthy choices and along with Uloric get it under control.
I had blood work done and my uric acid was 9.3, 36 my kidney function imo are not good Creatinine 1.26, eGFR 84…. this particular blood work I had done on my own with a “herbalist doctor” and they gave me a uric acid formula pills that includes Vitamin C 125mg, Potassium 100mg, Devils claw 100mg, Cherry extract 162mg, Quercetin 100mg, Bromelain 50mg, Grape extract seed 25mg.
Everything Ive read, and also per my doctor, it doesnt mean kidney issues, but it can lead to it. Go to your primary care doctor ASAP and get bloodwork done. The sooner you put a stop to whatever is causing your high UA, the better. Kidneys dont recover. Once theyre damaged, they only get worse.
This reflects my experience as well. Got gout, had kidneys tested, dr said they were fine but that they could decline if gout went untreated.
Another sign of kidney problems is protein in the urine. This will causing foaming in the urine when you pee. Doctors can measure this by taking a sample of your urine to a lab to measure the protein contents.
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The Link Between Gout And Kidney Disease
When your kidneys do not work the way that they should, it can lead to gout. Its important to treat and prevent future attacks of gout as it can lead to permanent joint and bone damage. Since kidney disease and gout are closely related, protecting your kidney function is one way to reduce symptoms of gout.
Role Of Combination Ult
Combination therapy with a XOI and a uricosuric can be very effective, and if uricosuric toxicity is a consequence of urate concentration within renal tubules then combination therapy could theoretically ameliorate such toxicity. However, as uricosuric treatment is usually not considered for patients with advanced CKD this approach is largely untested.
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Medicines For Gout Prevention And Complications
Your doctor can prescribe medicines to help keep a healthy level of uric acid in your body, which can prevent future gout attacks and the complications from gout. When you have gout, your body either makes too much uric acid or cannot get rid of enough of it, which causes it to build up.Some medicines are safe to take when you have kidney disease, but some are not. Talk to your doctor about which medicines are safe for you.
Allopurinol
Allopurinol is a medicine for people who make too much uric acid. It is the most common medicine used to treat chronic gout. Your doctor can tell you if allopurinol is safe for you to take if you have kidney disease.
Probenecid
Probenecid is a medicine that works for people who cannot get rid of enough uric acid. It works to remove extra uric acid through your urine. Probenecid can increase your risk of kidney stones. Probenecid is not safe to take for many people with kidney disease, so talk to your doctor for more information about probenecid.
Pegloticase
Pegloticase is an infusion medicine given by injection into your vein at a doctor’s office, usually every two weeks. It is used for severe chronic gout when other medicines do not work. Pegloticase can quickly bring your uric acid down to a lower level than most medicines can. Talk to your doctor about whether pegloticase is safe for you.