Investigators pooled results from 17 epidemiological studies of gout patients. Estimates of CKD (stage 3 and above) and nephrolithiasis among people with gout were 24% and 14%, respectively.
In addition, gout was linked with more than twice the odds of developing CKD and one and a half times the odds of ever developing nephrolithiasis. Few of the included studies were prospective, so the researchers couldn't assess timing.
According to the researchers, patients with gout should actively be screened for CKD and its related conditions. Currently, just 1 in 5 patients with acute gout are screened for CKD within a month of presentation.
There are several possible mechanisms by which gout could lead to CKD and kidney stones, they noted. Kidney damage may result from hypertension, diabetes, nonsteroidal anti-inflammatory drugs, and endothelial dysfunction from hyperuricemia. Or, persistent inflammation from gout may cause vascular damage.
Treatment with allopurinol was believed to interfere with kidney function, but a recent systematic review suggested that it actually may protect against CKD progression.
Gout is the most prevalent inflammatory arthritis, affecting 2.4% of adults in the UK. Gout is associated with considerable co-morbidity including hypertension, diabetes mellitus, obesity, metabolic syndrome, and vascular disease.
Associations between gout and renal disease and nephrolithiasis have long been recognised, yet early studies undertaken in specialist secondary care populations are likely to be unrepresentative of most patients with gout who are managed exclusively in primary care settings. To the best of our knowledge, no previous systematic reviews examining this association have been performed.