In summary, gout is a disease that has been studied for several millennia, but recent scientific and pharmacologic advances have provided exciting information. Most gout is due to increased proximal tubular reabsorption of urate, and the nephrologist has the best ability to determine why reduced urate excretion is occurring in a given patient. The frequent coexistence of gout and kidney failure results in nephrologists treating many individuals with gout. While allopurinol has been used as a treatment for gout for many decades, the proper dosing regimen in CKD has not been well studied. Future research will try to better define the role of allopurinol and febuxostat in treatment, and address how these agents may potentially slow progression of kidney disease and decrease morbidity from heart failure.

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