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Hyperuricemia and gout in renal transplant recipients

Michael A Becker, MD
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Albert Q Lam, MD


Reduced uric acid excretion can occur after renal transplantation, leading to hyperuricemia and, in some cases, gouty arthritis [1-3]. This problem is more common with cyclosporine [1,2,4,5]:

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 [1].

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) [5].

The lower glomerular filtration rate (GFR) induced by cyclosporine probably contributes to uric acid retention [1], but tubular damage may also be important by impairing urate secretion [2]. Concurrent diuretic use and renal insufficiency due to rejection are other risk factors for hyperuricemia [2]. (See "Diuretic-induced hyperuricemia and gout".)

Renal insufficiency predisposes to hyperuricemia and gout [6]. 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 [7]. 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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Literature review current through: Dec 2017. | This topic last updated: Jun 30, 2017.
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