Patient with gout is more likely to develop renal calculi
A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question: Explain why a patient with gout is more likely to develop renal calculi.
Sample Solution
Gout and kidney stones can both be incredibly painful conditions. They are both related to kidney function. Gout develops when the body has high levels of uric acid, a normal waste product. This is known as hyperuricemia. Uric acid is normally excreted through the body via the kidneys, but in some people, levels can remain high and uric acid can start to accumulate and crystallize in various joints. Can gout cause kidney stones? People with gout could be at a higher risk of developing uric acid kidney stones because they have a higher level of uric acid being excreted by the kidneys, and they have more acidic urine, which makes the uric acid more likely to form stones.
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