Nephrolithiasis in gout: prevalence and characteristics of Brazilian patients

Abstract Background: The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. Methods: One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in São Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. Results: One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 ± 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p < 0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. Conclusions: The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.(AU)

Gender-specific risk factors for gout: a systematic review of cohort studies

Abstract Background: Though gout is more prevalent in men than women, it remains unclear whether gender influences risk factors for incident gout. We aimed to systematically review all cohort studies examining risk factors for the development of gout by gender. Methods: MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched from inception to March 2019. Risk factors for gout examined were: age, ethnicity, consumption of alcohol, meat, seafood, dairy products, purine-rich vegetables, coffee and fructose, vitamin C intake, the Dietary Approaches to Stop Hypertension (DASH) diet, metabolic syndrome, BMI, waist and chest circumference, waist-to-hip ratio, weight change, diabetes mellitus, dyslipidaemias, renal disease, psoriasis, hypertension, diuretic use and anti-diabetic medication. Cohort studies were included if examining (at least) one of these risk factors for gout in either gender in the general population or primary care. Sample characteristics from included articles and their reported risk estimates were described using narrative synthesis. Results: Thirty-three articles were included, 20 (60.6%)directly compared risk factors by gender, 10 (30.3%) used men-only samples, 3 (9.1%) used women-only samples. Articles comparing risk across genders found similar increases in most risk factors. However, in men, metabolic syndrome (Hazard Ratio (95% CI) 1.37(1.20-1.58)) presented a risk of incident gout compared to none in women (> 50 years 1.15(0.85-1.54); ≤50 years 1.29(0.76-2.17)). Compared to men, women showed greater associated risk with higher consumption of fish and shellfish (HR (95% CI) Men: 1.02 (0.86-1.22); Women 1.36 (1.12-1.65)). Conclusions: Risk factors for developing gout did not typically differ between genders and therefore similar preventative advice can be provided. Exceptions were metabolic syndrome in men and excessive seafood consumption in women, but these singular articles need further examination and in general more research into the risk factors for gout which includes women is required.

Gota: estudio descriptivo en el Estado de Sonora (México) / Gout: Descriptive study in Sonora (Mexico)

Objetivo. La gota es una enfermedad común en México, que muchas veces la vemos poliarticular y erosiva. Se informan las características clínicas de un grupo de pacientes residentes en el Estado de Sonora (México), determinando si son sobreproductores o hipoexcretores y si el diagnóstico había sido correcto antes de la consulta de Reumatología, siguiendo los criterios del Colegio Americano de Reumatología. Resultado: Se reunieron 72 (68 hombres y 4 mujeres), con edades de 26 a 69 años (media 49.3), evolución de 1 semana a 20 años (mediana 30 meses), 40 con hábitos de alcoholismo de intensidad diversa, 12 tomaban furosemida, 48 obesos, 20 con hipercolesterolemia y 24 con hipertrigliceridemia; 28 hipertensos, 3 diabéticos y 4 en insuficiencia renal. El cuadro fue poliarticular en 60, 44 tenían erosiones y el diagnóstico previo fue correcto en sólo 16 pacientes. 32 eran hipoexcretores, 24 sobreproductores y 16 con mecanismo mixto. Conclusión. Nuestra población es diferente a la informada en la literatura: 90 a 95 por ciento son hipoexcretores en contraste con y 44 por ciento en nuestra serie. La ingestión de alcohol fue el factor precipitante en más de la mitad de los pacientes. Se necesita difundir el conocimiento del cuadro clínico de esta enfermedad, que aunque comúnmente es mono u oligoarticular, la mayoría presentaron cuadro apoliarticular, con erosiones y sin diagnóstico antes de la consulta especializada

Hiperuricemia y gota postrasplante

Evaluamos la frecuencia y probable potegénesis de la hiperuricemia (HU) y la gota que se presentan en pacientes con trasplante renal: 163 recibieron ciclosporina (CS), azatioprina (AZA) y prednisolona (grupo CS), y 147 azotioprina y prednisolona (grupo AZA). La HU se presentó en 76 por ciento del grupos CS, frente a 25 por ciento de AZA (P<0.00001). Catorce pacientes presentaron uno a más episodios de gora, 12 de grupo CS y dos del AZA (P<0.00001); en estos pacientes predominó el sexo masculino (92 por ciento), la edad fue 36ñ8 y 36ñ4 años respectivamente (NS), y la función renal (expresada como creatinina sérica) fue igual en los dos grupos (1.6ñmg/dL). Los niveles séricos de ácido úrico mostraron correlación directa con el uso de diuréticos (r=0.48,P=0.001). La incidencia de HU fue de 15 veces más frecuente en el grupo CS, sugiriendo una interferencia de la CS en la depuración renal de los uratos. A los 24 meses de seguimiento, 70 por ciento de las HUs había desaparecido concomitantemente con la disminución de las dosis de CS. En conclusiónlla HU secundaria al empleo de la CS es un fenómeno transitorio y dependiente de la dosis, y su posible explicación es un defecto tubular en la depuración del ácido úrico

Reporte de un caso de gota tofacea y poliarticular en una mujer con diagnóstico erróneo de artritis reumatóidea

Se reporta el caso de una paciente de sexo femenino, raza negra, 59 años de edad, con cuadro clínico de poliarteritis crónica y lesiones nodulares pretibiales, que fué diagnosticada y tratada por Artritis Reumatóidea durante un año.

Seudopodagra, presentación de cuatro casos y revisión de la literatura

Se presentan cuatro casos de mujeres jóvenes con cuadro clínico de inflamación aguda de la primera articulación metatarsofalángica y a quienes se les demostró en los rayos X calcificaciones a ese nivel. Consideramos que se trata de los primeros cuatro casos de suedopodagra por hidroxiapatita descritos en Colombia. Se hace una descripción yel diagnóstico diferencial de esta entidad

Gota: una revisión clínica / Gout: a clinical review

La gota es una enfermedad articular crónica, habitualmente autolimitada; a través del tiempo con cierta frecuencia se encuentran nódulos llamados tofos y se asocia a litiasis renal. Se analiza el metabolismo del ácido úrico, la incidencia de la enfermedad, el mecanismo de la inflamación. En el cuadro clínico se describe el ataque agudo, la gota crónica tofácea. Se hace énfasis en el tratamiento del ataque agudo, de la gota crónica y de la litiasis renal úrica

Studies on normal and abnormal excretion patterns of uric acid in Bahawalpur

Uric acid concentration in serum and urine of 296 persons of Bahawalpur city is reported. Although the general pattern corresponds to the studies in other regions of the world but the range of uric acid concentration in male and female serum and uric acid is slightly higher. Correspondingly the incidence of uricemia is also high in the region with some cases of gout. Statistically, the serum urate level were more compact and had smaller coefficient of variance. Only persons with serum urate level above 125mg/100ml showed signs and symptoms of gout

Net urate handling by renal tubules in maturity onset diabetics

An oral glucose tolerance test [OGTT] was performed and the serum levels of urate and creatinine were determined in 36 maturity-onset diabetics [MOD] and 10 normal controls. The rate of urine flow, the concentration of urate and creatinine were determined on 24 hours collected urine. From these determinations, creatinine clearance [C.C.], urate clearance [U.C.], urate load, final urate excretion per minute and net tubular urate reabsorption were calculated. When the diabetic patients, as a whole, were compared with normal controls, there is significant decrease in the C.C. and nonsignificant increase in U.C.; but when the nonproteinuric diabetics were compared with the controls, a significant elevation in U.C. was noticed. Both proteinuric and nonproteinuric diabetic patients showed a significant decrease in both the filtered urate load to renal tubules and tubular urate reabsorption, but the urate excretion is not significantly changed in the proteinuric 01 nonproteinuric diabetic patients. It is suggested that the increased urate clearance, reported in diabetics in the present investigation, is due to the presence of increased amounts of glucose in the tubular filtrate