Hyperuricemia and gout in renal transplant recipients
- Michael A Becker, MD
Michael A Becker, MD
- Section Editor — Crystal Diseases
- Professor Emeritus of Medicine
- University of Chicago Pritzker School of Medicine
- Section Editor
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
CONSIDERATIONS IN TRANSPLANT RECIPIENTS
TREATMENT OF ACUTE GOUT
Initial therapy —
PREVENTION OF RECURRENT GOUT
Indications for prophylaxis —
Goals of prophylaxis —
Selection of prophylactic therapy —
Urate-lowering medications —
Xanthine oxidase inhibitors —
Uricosuric agents —
Probenecid or sulfinpyrazone —
●The incidence of hyperuricemia in one study of renal transplant recipients was 84 percent in those treated with cyclosporine versus 30 percent in patients treated with azathioprine and prednisone .
●In a retrospective cohort study, there was an increased relative risk of new-onset gout with Neoral compared with tacrolimus (adjusted hazard ratio [HR] 1.25, 95% CI 1.07-1.47) .
The lower glomerular filtration rate (GFR) induced by cyclosporine probably contributes to uric acid retention , but tubular damage may also be important by impairing urate secretion . Concurrent diuretic use and renal insufficiency due to rejection are other risk factors for hyperuricemia . (See "Diuretic-induced hyperuricemia and gout".)
Renal insufficiency predisposes to hyperuricemia and gout . Patients with end-stage renal disease (ESRD) treated with maintenance dialysis, however, may be at lesser risk for symptomatic gout. Despite persistent hyperuricemia, patients with previous gouty arthritis note a marked reduction in symptomatic episodes, and de novo gout is a rare event . Why this occurs and whether it is applicable to transplant recipients are not clear; it is possible that the anti-inflammatory effect of persistent uremia is an important protective factor [7,8].
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- CONSIDERATIONS IN TRANSPLANT RECIPIENTS
- TREATMENT OF ACUTE GOUT
- Initial therapy
- PREVENTION OF RECURRENT GOUT
- Indications for prophylaxis
- Goals of prophylaxis
- Selection of prophylactic therapy
- Urate-lowering medications
- - Xanthine oxidase inhibitors
- - Uricosuric agents
- Probenecid or sulfinpyrazone
- - Uricase
- Acute gouty arthritis and gout flare prophylaxis
- - Colchicine
- - Nonsteroidal anti-inflammatory agents
- - Increased glucocorticoid dose
- Urate-lowering therapy
- - Xanthine oxidase inhibitors
- Modified mammalian recombinant uricase
- - Pegloticase
- Uricosuric agents
- - Probenecid or sulfinpyrazone
- - Losartan
- - Benzbromarone
- Investigational agents