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Harrison’s Principles of Internal Medicine 17 th Edition; 2154-2155

Harrison’s Principles of Internal Medicine 17 th Edition; 2154-2155 http://arthritis.emedtv.com/gout/gout-stages.html. Harrison’s Principles of Internal Medicine 17 th Edition. NEPHROLITHIASIS -Occurs most commonly but not exclusively in patients with gout

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Harrison’s Principles of Internal Medicine 17 th Edition; 2154-2155

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  1. Harrison’s Principles of Internal Medicine 17th Edition; 2154-2155 http://arthritis.emedtv.com/gout/gout-stages.html

  2. Harrison’s Principles of Internal Medicine 17th Edition

  3. NEPHROLITHIASIS -Occurs most commonly but not exclusively in patients with gout -Serum urate level of 770umol/L (13mg/dL) or urinary excretion >6.5mmol/d (1100mg/d) • URATE NEPHROPATHY(Uratenephrosis) -Rare cause of renal insufficiency attributed to monosodium urate crystal deposition in the renal interstitium • URIC ACID NEPHROPATHY -Reversible cause of renal of acute renal failure resulting from deposition of large amounts of uric acid crystals in the renal collecting ducts, pelvis and ureters Harrison’s Internal Medicine17th ed vol 2

  4. Reduce inflammation: Pharmacologic • NSAIDs • Colchicine • Glucocorticoids • ACTH MANAGEMENT OF UNCOMPLICATED ACUTE GOUTY ARTHRITIS NSAID choice are those of propionic acid derivatives which have short half-life i.e. ibuprofen, diclofenac, sulindac, naproxen • Reduce inflammation: • Non-pharmacologic • Ice packs • Rest of involved joints Harrison’s Principle of Internal Medicine 17th edition

  5. Control hyperuricemia: Pharmacologic MANAGEMENT OF UNCOMPLICATED ACUTE GOUTY ARTHRITIS • Probenecid • Allopurinol • Losartan, fenofibrate, amlodipine • Control hyperuricemia: • Non-pharmacologic • Low purine diet • Increased fluid intake • Prevent diuretics • Control body weight • Limit ethanol consumption Harrison’s Principle of Internal Medicine 17th edition

  6. NSAIDs • Salicylates (aspirin): blocks action of probenecid • Acetaminophen: renal tubular necrosis CONTRAINDICATED ANALGESICS TO THE PATIENT • Allopurinol • progressive renal insufficiency RENAL FAILURE • Colchicine • proteinuria, hematuria, tubular necrosis

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