What Chronic Gout Can Do to Your Kidneys

Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Nancy LeBrun
Updated on August 29, 2022

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Gout, recognized as the most prevalent form of arthritis, is characterized by its sudden onset of intense, needle-like pain and significant swelling, most commonly affecting the big toe. While many individuals experience episodic gout flares that resolve over time, a subset develops chronic gout, where joint inflammation persists. For those with chronic gout, the risk of developing kidney disease – a condition involving the gradual decline of kidney function – is notably elevated. This association between gout and kidney impairment has been acknowledged by medical professionals for decades, although the precise nature of their relationship has historically been a subject of extensive debate.

The core question often revolved around causality: does gout directly lead to kidney problems, or do pre-existing kidney issues predispose an individual to gout? While research continues to refine our understanding, the robust statistical link between these two conditions is undeniable. It is now widely understood that a bidirectional relationship exists, where each condition can exacerbate the other. Consequently, effective management of chronic gout is not only crucial for alleviating joint pain and inflammation but also serves as a vital strategy for safeguarding kidney health, reducing the likelihood of long-term complications in both organ systems.

How Chronic Gout Affects Your Kidneys

Healthy kidneys perform an array of essential functions, one of which is to meticulously filter and excrete excess uric acid from the body. When the kidneys fail to adequately remove uric acid, either due to overwhelming levels or impaired function, this substance accumulates, contributing significantly to the development of gout. Interestingly, uric acid, when circulating outside the cells, functions as an antioxidant, offering protective benefits. However, once it is absorbed into cells, its role shifts dramatically, promoting inflammation and instigating oxidative stress—an imbalance that undermines the body's natural capacity to prevent cellular and tissue damage.

The kidneys act as the sophisticated filtration system of the human body, meticulously processing blood to remove waste products. In this capacity, they efficiently filter uric acid into the urine for elimination. However, if the body produces more uric acid than the kidneys can process, or if kidney function is compromised, uric acid levels in the bloodstream begin to rise. This persistent elevation can lead to the formation of urate crystals. These microscopic, sharp crystals primarily deposit in the fluid surrounding joints, triggering the excruciatingly painful inflammation characteristic of a gout attack, marked by acute pain, swelling, and redness.

Beyond the joints, uric acid deposits can also accumulate within the kidneys themselves. This internal crystallization can manifest as painful kidney stones, which obstruct urine flow and lead to recurrent infections. More critically, sustained high levels of uric acid directly contribute to the progression of chronic kidney disease (CKD). Uncontrolled CKD gradually diminishes the kidneys' ability to filter blood, leading to a build-up of waste products and severe systemic health consequences. Patients may experience fatigue, nausea, and a general decline in well-being, along with the development of secondary conditions such as persistent high blood pressure, anemia, weakened bones, and nerve damage. Furthermore, kidney disease significantly increases an individual's susceptibility to serious cardiovascular events, including heart attack and stroke, underscoring the critical importance of effective management.

Keep Your Kidneys Healthy If You Have Chronic Gout

Effective management of chronic gout hinges on consistently lowering uric acid levels, a goal achieved through a combination of pharmacological interventions and dietary modifications. The frontline medication often prescribed for uric acid reduction is allopurinol (marketed as Zyloprim or Aloprim), which works by inhibiting an enzyme crucial for uric acid production. However, for individuals who do not respond adequately to allopurinol or experience intolerable side effects, alternative medications are available, each with its own set of considerations, particularly concerning kidney health.

It is important to note that certain alternative uric acid-lowering medications, including febuxostat (Uloric), probenecid (Benemid), and lesinurad (Zurampic), may pose challenges or require careful dosage adjustments for patients with existing kidney disease. Febuxostat, while effective, can be less suitable for those with severe kidney impairment. Probenecid and lesinurad, classified as uricosurics, enhance uric acid excretion by the kidneys, but their efficacy and safety profile can be compromised in individuals with reduced kidney function, potentially worsening kidney disease if not closely monitored. Therefore, a thorough discussion with your doctor about your kidney function is paramount when considering these treatment options.

Despite these considerations, viable options remain for patients with chronic gout and concurrent kidney issues. Pegloticase (Krystexxa) represents a distinct therapeutic approach. Administered via intravenous infusion, pegloticase is an enzyme that directly converts uric acid into a more soluble compound, facilitating its excretion and rapidly lowering uric acid levels. Critically, pegloticase does not exert adverse effects on the kidneys and has demonstrated effectiveness even in patients with pre-existing kidney disease. While highly effective, its long-term efficacy can sometimes wane, emphasizing the ongoing necessity of complementary strategies, particularly dietary adherence, to maintain stable uric acid levels.

Alongside medication, a well-structured diet plays a pivotal role in controlling uric acid levels and supporting kidney health for individuals with chronic gout. The cornerstone of such a diet involves minimizing the intake of purines, compounds naturally found in certain foods that are metabolized into uric acid within the body. Key dietary recommendations include strictly avoiding alcohol, especially beer, due to its high purine content and its ability to hinder uric acid excretion. Similarly, limiting consumption of red meat and shellfish, both rich in purines, is highly advisable. Conversely, incorporating specific foods can be beneficial; anecdotal evidence and some studies suggest that cherries, or cherry extract and juice, can actively help lower uric acid levels and reduce gout flares. Moreover, if kidney problems are present, consulting with your physician or a registered dietitian is crucial to determine appropriate daily fluid intake, ensuring adequate hydration without overtaxing already compromised kidneys.

The benefits of diligently managing chronic gout and keeping uric acid levels within a healthy range extend far beyond mere joint comfort. Patients often experience a significant reduction in both pain and systemic inflammation, leading to a marked improvement in their quality of life. Crucially, consistent uric acid control can prevent further kidney damage and, in some cases, lead to an improvement in kidney function for individuals already diagnosed with chronic kidney disease. Pioneering studies, particularly those conducted in the United Kingdom, have highlighted the profound systemic advantages of uric acid-lowering therapies, demonstrating that they can halve the rate of kidney disease progression and yield even greater reductions in the incidence of serious cardiovascular events such as heart attack or stroke. Ultimately, the interconnectedness of these bodily systems means that what is beneficial for managing chronic gout is equally beneficial for preserving the long-term health and function of your kidneys, emphasizing a holistic approach to patient care.

Original article: https://resources.healthgrades.com/right-care/gout/what-chronic-gout-can-do-to-your-kidneys