Gout, Stone Composition and Urinary Stone Risk: A Matched Case Comparative Study

Marchini, Giovanni Scala; Sarkissian, Carl; Tian, Devin; Gebreselassie, Surafel; Monga, Manoj

doi:10.1016/j.juro.2012.09.102

Cited by 38 publications

(23 citation statements)

References 18 publications

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“…Adequately dosed allopurinol treatment decreases the proportion of urate-containing NL in patients with gout [34]. In addition, allopurinol has been shown to have a possible protective effect against recurrent calcium NL in individuals forming calcium stones in one RCT [18, 35].…”

Section: Discussionmentioning

confidence: 99%

Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study

et al. 2017

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BackgroundNephrolithiasis (NL) is known to be associated with gout, although there are few comparative studies on risk and risk factors for NL in gout compared to population cohorts. In this cohort study we investigated: (1) overall incidence of NL in gout (cases) and general population controls; (2) risk and risk factors (common comorbidities and medications) for first-time NL in cases and controls separately.MethodsCases (n = 29,968) and age-matched and sex-matched controls (n = 138,678) were identified from the regional healthcare database in western Sweden (VEGA). The analyzed risk factors (comorbidities and current medication use) for first-time NL, and socioeconomic factors were retrieved from VEGA and other national Swedish registers. For cases, follow up began on 1 January 2006 or on the first diagnosis of gout if this occurred later, and for controls on their index patient’s first diagnosis of gout. Follow up ended on death, emigration or 31 December 2012. Incidence rates (IR) per 1000 person-years and hazard ratios (HR) were calculated. The incidence calculations were performed for cases (regardless of prior NL) and their controls. HRs with first occurrence of NL as outcome were calculated only in those without previous NL.ResultsIn cases there were 678 NL events (IR: 6.16 events per 1000 person-years (95% CI: 5.70–6.64) and in controls 2125 NL events (IR 3.85 events per 1000 person-years (95% CI: 3.69–4.02), resulting in an age-sex-adjusted incidence rate ratio of 1.60 (95% CI:1.47–1.74).Point estimates for predictive factors were similar in cases and controls, except for a significant interaction for losartan which increased the risk of NL only in controls (HR = 1.49 (95% CI: 1.03–2.14). Loop diuretics significantly decreased the risk of NL by 30–34% in both cases and controls. Further significant predictors of NL in gout cases were male sex, diabetes and obesity and in controls male sex and kidney disease.ConclusionsThe risk (age and sex adjusted) of NL was increased by 60% in cases compared to controls. None of the commonly used medications increased the risk of NL in gout patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1376-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study

et al. 2017

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“…Treatment of patients with gout and urolithiasis with ULT is supported by observational studies, 47 while the recommendation to consider ULT in pa tients taking diuretic drugs is supported by co hort and case control studies which demonstrat ed higher risks of gouty arthritis in users com pared with nonusers of diuretics.…”

Section: 44-46mentioning

confidence: 99%

Current management of gout: practical messages from EULAR 2016 guidelines

Nuki¹,

Doherty²,

Richette³

2017

Polish Archives of Internal Medicine

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REVIEW ARTICLE Current management of gout: practical messages from 2016 EULAR guidelines 267 where these differ significantly from the earli er guidelines and other recent national and in ternational recommendations for the manage ment of gout.Why do we need updated recommendations? There were at least half a dozen good reasons why the EULAR recommendations needed to be up dated in 2016. 1 Knowledge of the pathophysiology of uric acid (UA) transport, urate crystal inflammation, and the comorbidities associated with gout had ad vanced considerably. 2 New pharmaceutical options had become available and the evidence base for the efficacy and safety of available drugs had expanded in the last decade. 3 The incidence, prevalence, and severity of gout had continued to increase 7 despite the availability Introduction Gout is a chronic crystal deposition disorder in which crystals of monosodium urate can cause chronic arthritis, tophi, urolithiasis and renal disease, as well as recurrent acute arthritis and bursitis. Gouty arthritis and tophi can lead to chronic disability and impairment of health related quality of life, 1 but gout is also frequently associated with comorbidities such as obesity, di abetes mellitus, hypertension, and cardiovascular disease, 2,3 as well as with increased mortality. 3,4 The ABSTRACTThe European League Against Rheumatism published updated recommendations for the management of gout in 2016, comprising 3 overarching principles and 11 key recommendations for clinical practice. Patient education about the pathophysiology of gout and its comorbidities, as well as the existence of effective treatments are important, and understanding the principles of managing acute attacks and eliminating urate crystals by lifelong lowering of the serum urate (SU) below a target level are essential. Advice about lifestyle, diet, weight, and other risk factors, as well as the need to screen for and manage comorbidities are emphasized. For the treatment of flares, colchicine, nonsteroidal anti -inflammatory drugs (NSAIDs), and oral or intraarticular steroids, or a combination thereof, are recommended. In patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids, an interleukin -1 blocker should be considered. Urate -lowering therapy (ULT) should be discussed from the first presentation of the disease, and SU levels should be maintained at less than 6 mg/dl (360 µmol/l), or less than 5 mg/dl (300 µmol/l) in patients with severe gout. Allopurinol is recommended as first -line ULT with dose adjustment according to renal function. If the SU target cannot be achieved with allopurinol,

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“…UA stones constitute about 10% of urolithiasis in the general population, but this percentage increases up to 34 % of stones in patients with metabolic syndrome and up to 52.2% of stones in patients with gout. 138,139 UA stones are typically radiolucent on plain radiographs and of low attenuation values (<500 HU) on non-contrast CT scans of the abdomen. 140 Recently, dual-energy CT scanning has been found to be superior to the conventional "single-energy" non-contrast CT scanning in differentiating non-uric acid stones from UA stones.…”

Section: Uric Acid Stonesmentioning

confidence: 99%

CUA Guideline: Management of ureteral calculi

Ordon

Andonian²,

Blew³

et al. 2015

CUAJ

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The focus of this guideline is the management of ureteral stones. Specifically, the topics covered include: conservative management, medical expulsive therapy, active intervention with either shockwave lithotripsy (SWL) or ureteroscopy (URS), factors affecting SWL treatment success, optimizing success, and special considerations (e.g., pregnancy, urinary diversion). By performing extensive literature reviews for each topic evaluated, we have generated an evidence-based consensus on the management of ureteral stones. The objective of this guideline is to help standardize the treatment of ureteral stones to optimize treatment outcomes.

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Gout, Stone Composition and Urinary Stone Risk: A Matched Case Comparative Study

Abstract: Uric acid stones are the most common pure stone composition in patients with gout but 48% have nonuric acid stones. Allopurinol changes the stone composition distribution in patients with gout to a pattern similar to that in stone formers without gout.

Cited by 38 publications

References 18 publications

Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study

Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study

Current management of gout: practical messages from EULAR 2016 guidelines

CUA Guideline: Management of ureteral calculi

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