Treating gout in kidney transplant recipients.
OBJECTIVE
To review the etiology, treatment, and preventive strategies of hyperuricemia and gout in kidney transplant recipients.


METHODS
Primary literature was obtained via Medline (1966-June 2003).


METHODS
Studies evaluating treatment and prevention of hyperuricemia and gout in kidney transplantation were considered for evaluation. English-language studies were selected for inclusion.


RESULTS
Approximately 14,000 kidney transplantations were performed in the United States in 2003, and of those transplant recipients, nearly 13% will experience a new onset of gout. The prevalence of hyperuricemia is even greater. There are several mechanisms by which hyperuricemia and gout develop in kidney transplant recipients. Medication-induced hyperuricemia and renal dysfunction are 2 of the more common mechanisms. Prophylactic and treatment options include allopurinol, colchicine, corticosteroids, and, if absolutely necessary, nonsteroidal antiinflammatory drugs.


CONCLUSIONS
It is generally recommended to decide whether the risks of prophylactic therapy and treatment outweigh the benefits. Often, the risk of adverse events associated with agents to treat these ailments tends to outweigh the benefits; therefore, treatment is usually reserved for symptomatic episodes of acute gout. Practitioners must also decide if changes in immunosuppressive regimens may be of benefit on a patient-by-patient basis.
Baroletti
Steven
S
Brigham and Women's Hospital, Boston, MA, USA.
Bencivenga
Gina Ann
GA
Gabardi
Steven
S
D000208:Acute Disease; D015984:Causality; D018753:Diet, Protein-Restricted / Q000379:methods; D004334:Drug Administration Schedule; D006073:Gout / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006074:Gout Suppressants / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008460:Meat / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D015995:Prevalence; D017747:Seafood / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
D006074:Gout Suppressants; D007166:Immunosuppressive Agents