There is an uncle, 50 years old, slightly fat, hyperuricemia for more than 10 years, blood uric acid highest 620μmol / L, the lowest after diet control is 540μmol / L. He usually does not need medicine, and he uses a painkiller when there is a gout attack.
A few days ago, the physical examination found that serum creatinine was elevated and came to the clinic. I gave him an ECT examination and found that the bilateral kidneys were slightly atrophied. The glomerular filtration rate was 58 ml/min. It was already CKD stage 3 and moderate renal failure. . After examination, other kidney diseases were ruled out, and the diagnosis was hyperuric acid nephropathy, chronic renal failure, and uric acid was given to febuxostat.
He had long known that he had high uric acid, but he always thought that hyperuricemia was caused by gout, and it was not terrible without gout. During the gout attack, he used painkillers, no pain, and the uric acid-lowering measure was to control diet and lose weight.
“As long as gout does not occur, high uric acid is not terrible”; “As long as it does not hurt, high uric acid will not be taken care of.” In fact, these are very wrong understandings, and many people in life have such misunderstandings.
In addition to causing gouty arthritis, hyperuricemia causes tophi, uric acid kidney stones, hyperuric acid nephropathy, and chronic renal failure. The medical profession refers to the above situation as gout, but it is customary for people to only call gout arthritis, and I will call it that way.
According to statistics, if blood uric acid is >392μmol/L, the risk of chronic renal failure increases by 94% in men and 420% in women. Moreover, for every 60 μmol/L of blood uric acid, the risk of acute renal failure increased by 74%. In addition to causing kidney damage, hyperuricemia also increases the risk of hypertension, diabetes, coronary heart disease, and cerebral infarction.
Therefore, regardless of consideration of the control of gout attacks, or prevention of complications of high uric acid, expert consensus suggests:
If blood uric acid> 540μmol / L, regardless of the symptoms should be unconditional start drug uric acid treatment, the treatment target is uric acid <420μmol / L;
If blood uric acid > 480μmol / L, any cardiovascular risk factors (such as hypertension, diabetes, hyperlipidemia, proteinuria, smoking, etc.) should also begin to reduce uric acid treatment, the goal of treatment is blood uric acid <360μmol / L;
If the onset of gouty arthritis ≥ 2 times, or the onset of gouty arthritis, and combined with any cardiovascular risk factors, as long as the uric acid exceeds the normal value, uric acid treatment begins. The goal of treatment is blood uric acid <300μmol/L.
There are some misunderstandings about gout. For example, many people think that gout is eaten. As long as you control your diet, you can avoid gout. Is this really the case?
I will talk about two more cases of my treatment.
A 25-year-old boy
Seeing because of elevated serum creatinine (decreased renal function). A few years ago, he was admitted to the university for physical examination and found hyperuricemia, but it was not taken seriously. In the past 2 years, there was occasional gout attack, and no other treatment was given after pain relief. The examination found that he had no hypertension and proteinuria, but his renal function had been mildly reduced, considering hyperuric acid nephropathy.
His father and uncle have gout, and they have already suffered from kidney failure. Because of his father’s relationship, he paid special attention to diet and never dared to eat it, but he still did not escape the damage of high uric acid.
A 70-year-old man
Because of hyperuricemia, recurrent gouty arthritis, gouty nephropathy was once hospitalized in our department, when blood uric acid 750μmol / L, mild renal failure, after treatment, improved and discharged.
After leaving the hospital, his child heard that the benzbromarone had damaged the kidney and stopped him. He was worried about blood uric acid rebounding. So he strictly controlled his diet and forbidden him to drink. All meat and seafood would not let him. eat. As a result, such a harsh diet was controlled for a month, and his gout was still a long time, and the blood uric acid was still high, and there was no significant decrease.
The old man complained to me that he is not as good as a monk now. He now feels very boring.
I told his children that there is no reason to stop benzolamone. The effect of reducing uric acid through diet control is limited. Gout patients also need nutrition. They don’t let anything eat. If they continue, they will be malnourished.
Excessive production of uric acid, or uric acid excretion disorder is the root cause of hyperuricemia. It is currently believed that the cause of excessive and excretory barriers is half. 80% of uric acid production comes from the metabolism of body cells, and only 20% comes from food.
Therefore, high uric acid is not completely eaten, and the effect of reducing uric acid through diet control is also limited. The study found that even with strict dietary control, the reduction in uric acid was not as high as 100 μmol/L.
Therefore, for gout patients, just controlling diet is not enough. To stay away from gout, you should also use uric acid-lowering drugs, including drugs that reduce uric acid production, such as allopurinol, febuxostat, and benzolamone, a drug that promotes uric acid excretion. This needs to be used under the guidance of a doctor.
Many patients complain that the gout is not cured and can’t get rid of the pain of gout. There are reasons for gout itself, but more because of the misunderstanding of gout.
To get rid of gout and avoid complications caused by hyperuricemia, you should pay attention to:
1. Gout is caused by hyperuricemia, but hyperuricemia does not only cause gout, but also kidney damage, and may be a risk factor for heart disease, hypertension, and metabolic syndrome.
2. Excessive production of uric acid, or reduced uric acid excretion is the two major factors of hyperuricemia, dietary factors are only a small part of the reason, so strict diet control can not avoid gout attacks.
3. The root cause of gout is hyperuricemia, but cold, joint damage, sudden increase in uric acid (drinking, overeating, drugs, etc.), sudden decrease in uric acid (lowering uric acid) can induce gout attacks, control these induced Factors can reduce the onset of gout.
4. In order to “long-term cure” to avoid gout attacks, the long-term control of uric acid should be up to standard, the specific criteria is: the average person, the uric acid control below 420μmol / L; there is gout, or a cardiovascular risk factors should be combined The uric acid is controlled below 360 μmol/L; if recurrent gout, or chronic gouty arthritis, or tophi, or gouty nephropathy, the uric acid should be controlled below 300 μmol/L. This may take a lifetime medication.