Aim: To evaluate the effect of nonsteroidal anti-inflammatory drug (NSAID) withdrawal on renal function in patients with chronic gout after proper control of hyperuricemia and gouty symptoms. Methods: Patients with chronic gout, who regularly used NSAIDs to control gouty symptoms prior to urate-lowering therapy, were prospectively followed up in an observational study. Risk factors for renal function impairment were recorded, and the clearance of creatinine (Ccr) was initially measured while on colchinine therapy to prevent gouty bouts. Therapy with urate-lowering drugs was started in order to keep serum urate levels under 6.0 mg/dl (275 µmol/l), and the Ccr was monitored during the follow-up period. Final assessment of the renal function was made after 1 year free from gouty bouts and without NSAID therapy during this period. Results: 87 patients completed a 1-year period of NSAID withdrawal. Low initial Ccr was related to age, hypertension, hypertriglyceridemia and the presence of previous renal diseases. After proper control of gout and NSAID withdrawal during 1 year, the mean Ccr significantly raised from 94 to 104 ml/min. The improvement was especially significant in patients whose initial Ccr was under 80 ml/min. Their mean Ccr rose from 60 to 78 ml/min, and 12 of 29 patients achieved normal Ccr at the end of the study. No risk factor correlated with improvement of the renal function. Conclusions: Renal function impairment in patients with chronic gout is mainly related to vascular risk factors, but improvement of the renal function was observed after proper control of hyperuricemia and NSAID withdrawal. Optimal control of hyperuricemia and, therefore, of symptoms of gout should be especially considered in patients with vascular risk factors in order to avoid renal function loss due to NSAID use.

Tarng DC, Lin HY, Shyong ML, Wang JS, Yang WC, Huang TP: Renal function in gout patients. Am J Nephrol 1995;15:31–37.
Berger L, Yü TF: Renal function in gout IV. An analysis of 524 gouty subjects including long-term follow-up studies. Am J Med 1975;59:605–613.
Yü TF, Berger L: Impaired renal function in gout. Its association with hypertensive vascular disease and intrinsic renal disease. Am J Med 1982;72:95–100.
Miranda-Carus E, Mateos FA, Herrero E, Ramos T, Puig JG: Purine metabolism in patients with gout: The role of lead. Nephron 1997;75:327–335.
Nickeleit V, Mihatsch MJ: Uric acid nephropathy and end-stage renal disease: Review of a non-disease. Nephrol Dial Transplant 1997;12:1832–1838.
Segasothy M, Chin GL, Sia KK, Zulfiqar AN, Samad SA: Chronic nephrotoxicity of anti-inflammatory drugs used in the treatment of arthritis. Br J Rheumatol 1995;34:162–165.
Henry D, Page J, Whyte I, Nanra R, Hall C: Comsumption of non-steroidal anti-inflammatory drugs and the development of functional renal impairment in elderly subjects: Results of a case-control study. Br J Clin Pharmacol 1997;44:85–90.
Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF: Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977;20:895–900.
Hande KR, Noone RM, Stone WJ: Severe allopurinol toxicity: Description and guidelines for prevention in patients with renal insufficiency. Am J Med 1984;76:47–56.
Unsworthy J, Sturman S, Lunec J, Blake DR: Renal impairment associated with non-steroidal anti-inflammatory drugs. Ann Rheum Dis 1987;46:233–236.
Sandler DP, Smith JC, Weinberg CR, Buckalew VM Jr, Dennis VW, Blythe WB, Burgess WP: Analgesic use and chronic renal disease. N Engl J Med 1989;320:1238–1243.
Bennett WM, Debroe ME: Analgesic nephropathy – a preventable renal disease. N Engl J Med 1989;320:1269–1271.
Gonzalez EB, Miller SB, Agudelo CA: Optimal management of gout in older patients. Drugs Aging 1994;4:128–134.
Vora JP, Dolben J, Dean JD, Thomas D, Williams JD, Owens DR, Peters JR: Renal hemodynamics in newly presenting non-insulin dependent diabetes mellitus. Kidney Int 1992;41:829–835.
Grodzicki T, Palmer A, Bulpitt CJ: Incidence of diabetes and gout in hypertensive patients during 8 years of follow-up. J Hum Hypertens 1997;11:583–585.
Messerli FH, Fröhlich ED, Drelinski GR, Suarez DH, Aristimuno GG: Serum uric acid in essential hypertension: An indicator of renal vascular involvement. Ann Intern Med 1980;93:817–821.
Koh WH, Seah A, Chai P: Clinical presentation and disease associations of gout: A hospital-based study of 100 patients in Singapore. Ann Acad Med Singapore 1998;27:7–10.
Nishioka K, Iwatani M: Hyperuricemia and atherosclerosis. Nippon Rinsho 1993;51:2177–2181.
Yü TF, Oreskes I: Lipid studies in primary gout. Mt Sinai J Med 1989;56:11–16.
Rosenfeld JB: Effect of long-term allopurinol administration on serial GFR in normotensive and hypertensive hyperuricemic subjects. Adv Exp Med Biol 1976;41:581–596.
Schlöndorff D: Renal prostaglandin synthesis: Sites of production and specific actions of prostaglandins. Am J Med 1986;81:1–11.
Scharschmidt LA, Simonson MS, Dunn MJ: Glomerular prostaglandins, angiotensin II, and nonsteroidal anti-inflammatory drugs. Am J Med 1986;81:30–42.
Abraham PA, Keane WF: Glomerular and interstitial disease induced by nonsteroidal anti-inflammatory drugs. Am J Nephrol 1984;4: 1–6.
Johnson RJ, Kivlighn SD, Kim Y-G, Suga S, Fogo AB: Reappraisal of the pathogenesis and consequences of hyperuricemia in hypertension, cardiovascular disease, and renal disease. Am J Kidney Dis 1999;33:225–234.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.