A 53-year-old man has had gout for many years, and usually experiences 4–5 attacks a year. He is not on any medications for gout prophylaxis, and takes an over-the-counter nonsteroidal anti-inflammatory drug (NSAID)
to treat his flares. On examination, there are no active joints presently, but he does have some
tophaceous deposits on his left hand. As part of his complete evaluation, screening for renal complications is performed. Which of the following findings is most likely compatible with chronic gouty nephropathy?
(A) nephrotic syndrome
(B) decrease urinary concentrating ability
and proteinuria
© acute renal failure
(D) acute tubular necrosis (ATN)
(E) malignant hypertension
ans:
Diminished concentrating ability and proteinuria occur even when the glomerular filtration rate is near normal. The severity of renal involvement correlates with the duration and magnitude of serum uric acid elevation. Uric
acid and monosodium urate deposit in the renal parenchyma. These deposits can cause intrarenal obstruction and elicit an inflammatory response as well. Hypertension, nephrolithiasis, and pyelonephritis can also contribute to the nephropathy of gout