The Nephropathy of Gout

Fineberg, S. K.; A, Altschul

doi:10.7326/0003-4819-44-6-1182

Cited by 22 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In almost all reports, urate deposition was seen in the renal medulla both within the collecting ducts and medullary interstitium [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ] ( Figure 2 A). It is postulated that uric acid initially precipitates in the collecting tubules secondary to their low pH environment.…”

Section: Resultsmentioning

confidence: 97%

“…The alkaline pH and high sodium concentration milieu of the medulla transforms uric acid to MSU with formation of microtophi [ 32 ]. On gross pathology, renal urate deposits are described as thin yellowish chalk-like streaks extending through the renal medulla to the tips of the papilla [ 29 ]. On histopathology, the collecting tubules showed dilatation, hyaline degeneration and distortion.…”

Section: Resultsmentioning

confidence: 99%

“…In 89% of cases, urate deposits were surrounded by numerous inflammatory cells including lymphocytes, mononuclear inflammatory cells and giant cells. Adjacent to, and intermingled with peri-tubular inflammation were regions of tubulointerstitial fibrosis presumably secondary to chronic inflammation [ 25 , 26 , 29 , 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…Renal vasculature involvement including nephrosclerosis, glomerulosclerosis and arteriosclerosis were reported in 74% of cases by histopathology and autopsy ( Figure 2 B,C). Hyaline degeneration and intimal thickening of the small and medium sized arteries, as well as the arterioles, with occlusions/near occlusions of the arterioles, were commonly found [ 27 , 28 , 29 , 30 , 34 , 35 ]. Medial thickening and prominent subintimal collagen have also been frequently reported in the interlobar arteries [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Khanna

Johnson

Marder

et al. 2020

JCM

View full text Add to dashboard Cite

Gout, an inflammatory arthritis, affects over nine million people in the US with increasing prevalence. Some medical societies do not recommend treating gout unless it is recurrent. While soft tissue urate deposits (tophi), resultant bone erosions, and joint inflammation are frequently recognized in gout, urate crystal deposits in other sites have been thought to be rare. Recent diagnostic testing, such as dual energy computed tomography (DECT), has led to the recognition that urate deposits are not uncommon in other tissues including the vasculature. To understand the potential risks for untreated gout, we reviewed the literature on extra-articular urate deposition documented by autopsy, histopathology, surgery, and radiology, including the heart, blood vessels, kidney, spine, eye, skin, and gastrointestinal system. These studies extend the significance of gout beyond the rheumatologist and emphasize the need for physicians to follow the American College of Rheumatology guidelines to treat subjects with gout to a goal of achieving serum urate <6 mg/dl. Given the growing body of literature on extraarticular urate deposition, further studies and clinical trials are needed to determine the clinical consequences of systemic urate deposition, including if reducing cardiac and vascular urate deposits may provide a survival benefit for this at-risk population.

show abstract

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Khanna

Johnson

Marder

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…Round, smooth, white stones were seen in the tips of the pyramids [105]. Dilation and thickening of renal pelvis was described [106]. In a post-mortem case series of kidney pathology in patients with severe gout in the pre-urate lowering therapy era, kidney stones were observed in some patients, but were not universally observed [105].…”

Section: Resultsmentioning

confidence: 99%

The anatomical pathology of gout: a systematic literature review

Towiwat

Chhana

Dalbeth

2019

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background The aim of this systematic literature review was to comprehensively describe the anatomical pathology of tissues affected by gout. Methods We searched PubMed, The Cochrane Library, Excerpta Medica Database (EMBASE), and Web of Science Core Collection for all English language articles published before March 2018. Articles were included if they described the microscopic or macroscopic appearances of gout in human tissue. Results Four hundred and seventeen articles met inclusion criteria and were included in the review. Articles describing the anatomical pathology of gout in musculoskeletal structures, including bone, tendon and ligaments, synovium and cartilage, were most common. Articles describing skin and kidney pathology in gout were also common, with pathology in other sites such as visceral organs less common. At all sites, monosodium urate crystal deposition was reported, and the tophus was also described within many different tissues. During a gout flare, diffuse acute neutrophilic synovial inflammation was evident. The tophus was described as an organised chronic giant cell granulomatous structure consisting of monosodium urate crystals, innate and adaptive immune cells, and fibrovascular tissue. Conclusions Consistent with the clinical presentation of gout, most studies describing the anatomical pathology of gout report involvement of musculoskeletal structures, with monosodium urate crystal deposition and tophus the most common lesions described. This review details the anatomical pathology features of gout at affected sites. Electronic supplementary material The online version of this article (10.1186/s12891-019-2519-y) contains supplementary material, which is available to authorized users.

show abstract

Uricosuric Agents and Phenolsulfonphthalein Excretion

Newcombe¹,

Cohen²

1963

Arch Intern Med

View full text Add to dashboard Cite

The Nephropathy of Gout

Cited by 22 publications

References 9 publications

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Systemic Urate Deposition: An Unrecognized Complication of Gout?

The anatomical pathology of gout: a systematic literature review

Uricosuric Agents and Phenolsulfonphthalein Excretion

Contact Info

Product

Resources

About