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Gout, uric acid and renal disease.

Gout may be associated with renal disease in two situations: (i) when the abnormal urate metabolism is the primary phenomenon and renal disease occurs secondary to this; or (ii) when the intrinsic renal disease is primary, and results in secondary abnormalities of renal function. Kidney damage secondary to gout is associated with urate deposits either in the intersitium as microtophi or as uric acid crystals within tubules, and vascular disease and infection are superimposed. Hyperuricaemia is a frequent sequel to parenchymal renal disease, but gouty arthritis develops only when the hyperuricaemia is unusually severe. Urate metabolism alters when renal excretion of urate is reduced. The management of these problems is discussed.