1/8. The influence of allopurinol on renal function in gout.Our data demonstrate that adequate control of uric acid production and serum acid concentration in primary gout arrests further deterioration of renal function and in some instances permits subsequent improvement in renal hemodynamic function even when renal impairment is clearly established. In considering the nature of the lesions of urate nephropathy, our study suggests that control of serum uric acid with drug therapy before renal involvement is apparent might prevent or significantly delay the morbidity and mortality of this complication of primary gout.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. gout due to renal disease.From 120 patients attending a referral gout clinic, 12 patients were found to have primary renal disease at the time of, or prior to, their first attack of acute gouty arthritis. This number excluded those with chronic lead nephropathy, polycystic kidneys or who were receiving diuretics. The nature of the renal disease was usually of the tubulointerstitial variety rather than of glomerular origin. The renal clearance of urate per unit of glomerular filtration rate, which usually increases with renal disease, was generally reduced, suggesting impairment of renal excretion of urate. Nine of the patients were female (four premenopausal) and only three were males. The degree of renal impairment was only mild to moderate. Other common associations with gout, such as obesity, hypertension and regular alcohol consumption, were not prominent. The intrinsic renal disease in these patients was considered to be the major contributor to their development of hyperuricaemia and gout.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. Familial juvenile gouty nephropathy with renal urate hypoexcretion preceding renal disease.This paper reports investigations in a young woman with renal disease and six other seemingly healthy young members of a new kindred (four male:two female) with familial juvenile gouty nephropathy (McKusick 16200). The family had previously been known to have a "familial" renal disease, but came to attention through an isolated episode of gout in the propositus when renal function was already impaired. A reduced GFR was found in three of the other six subjects. hyperuricemia associated with a grossly reduced fractional uric acid clearance (Cur/Ccr x 100) was present in the propositus and five kindred members, three of whom were children. The finding of this abnormality in two subjects with normal GFR suggests that this apparent hallmark of the disease precedes the onset of renal damage. The results confirm the dominant nature of the disorder, and highlight the need to investigate all kindred members of patients with juvenile gout and renal failure. Early recognition is important, since allopurinol therapy in doses adjusted to the reduced renal function may ameliorate the progression of the renal lesion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Case report 591: Osteoarthrosis (OA) of hip associated with microscopic gouty tophi.It has been demonstrated in this 58-year old woman that osteoarthrosis OA coexisted in a hip with microscopic gouty tophi. It is demonstrated that the bone erosions around the hip in this case were due to OA and not gouty arthritis. It is believed that OA is not a consequence of gout and that such an association between gout and OA is exceptional. It is maintained that a true association exists between OA and ochronosis while a relationship may exist between OA and chondrocalcinosis, but the nature of this relationship is not clear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. The medical/surgical management of gout.hyperuricemia and gout are common clinical entities. The pathogenesis, clinical presentation, and medical/surgical management of gout are reviewed. A case of chronic tophaceous gout exemplifying the multifaceted nature of the disease is presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. Coexistent gout and septic arthritis: a report of two cases and literature review.Two cases of coexistent gout and septic arthritis are presented. The known increased incidence of joint injections in patients with rheumatoid arthritis is contrasted with the relative rarity of this complication in persons with gouty arthritis. The reason for this dichotomy is not clear but it is suggested that an important factor may be the more episodic nature of the gouty process. For patients presenting with acute arthritis the possible concurrence of sepsis and gout should be considered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. Complete destruction of both femoral heads following idiopathic necrosis of the femoral heads in a diabetic patient with hyperuricemia and hyperlipoproteinemia.A practically complete destruction of both femoral heads including the femoral necks and acetabula was encountered in a 69-year-old patient with diabetes, which varied in intensity. This destruction, documented by radiographs which had been taken 8 years prior, had started as the typical picture of "idiopathic femoral head necrosis". In addition to diabetes, hyperuricemia and hyperlipoproteinemia were present at the time when the femoral head necrosis was first evidenced. One episode of gout was recorded. In recent years, following therapy, the hyperurecemia and hyperlipoproteinemia had normalized. The question is raised, as to whether or not the present radiological findings represent a complication of aseptic femoral head necrosis, combined with a diabetic arthropathy of the hip joints. Details of the angiographic findings and a spondylopathy, which have all the characteristics of a neuropathic spondylopathy, would favor this hypothesis. When associated with a diabetic condition, generalized osteoporosis and hypertrophic spondylosis of such a particular nature require special mention.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. Long-term follow-up of incorporation of 15N from glycine into uric acid in gout.The incorporation of 15N-glycine into urinary uric acid was studied in three gouty patients, repeating a study carried out 13 to 27 years ago. The 15N incorporation attained a lower maximum and declined less rapidly in the repeat study in all three patients. The cumulative 15N incorporation into uric acid was reduced to one half of that determined previously. Similarly, urinary uric acid excretion was less, along with a lower uric acid nitrogen to total nitrogen ratio. The data indicate changes in the nature of the metabolic aberrations, which are apparently related to long-term drug therapy, changes in lifestyle, aging and associated medical complications.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |