PATHOPHYSIOLOGY

Gout is a type of inflammatory arthritis that causes pain and swelling in your joints,
usually as flares that last for a week or two, and then resolve. Gout flares often begin in your
big toe or a lower limb. Gout attacks are especially common in joints at the ends of your legs
and arms, such as in your fingers and toes. This may be because these parts of the body are
cooler, and low temperatures make it more likely for crystals to form. Gout is caused by a
condition known as hyperuricemia. This is when there is too much uric acid in the body. The
body makes uric acid when it breaks down purines and high levels of uric acid can lead to the
formation of crystals in the joints, causing gout. If you have gout or are at risk of developing it,
it's important to be mindful of your purine intake.

Limit very high-purine foods, including:

Organ meats, such as liver, kidneys, sweetbreads, and brains.
Meats, including bacon, beef, pork, and lamb.
Anchovies, sardines, herring, mackerel, and scallops.
Gravy.
Alcohol, especially beer and hard liquor.
 PRE-DISPOSING FACTORS PRECIPITATING FACTORS
-Family History (-) -Diet and Lifestyle
-Age (69) -Weight
-Gender (Men) -Medical Conditions
-Race (Asian) -Medications
NOTES

1.

Xanthine oxidase (XO) is an important enzyme catalyzing the hydroxylation of hypoxanthine to xanthine and
xanthine to uric acid which is excreted by kidneys. Excessive production and/or inadequate excretion of uric acid
results in hyperuricemia.

Renal Arteriopathy is the calcification and necrosis of the renal arterioles

2.

 Hyperuricosuria generally defined as a urine uric acid excretion above 800 mg/day in men, and 750
mg/day in women.
 ACIDURIA is the condition of having acid in the urine especially in abnormal amounts.
 Urolithiasis is the formation of urinary calculi (“stones”) in the urinary system.
 Uric acid crystals [monosodium urate (MSU)] have emerged as an important factor for both gouty
arthritis and immune regulation. This simple crystalline structure appears to activate innate host defense
mechanisms in multiple ways and triggers robust inflammation and immune activation.
 Tophi are stone-like deposits of monosodium urate in the soft tissues, synovial tissues, or in bones near
the joints.

CKD
 Kidney Tubular atrophy is an injury with thickened tubular basement membranes, and clinically manifests
as chronic kidney disease with decreased glomerular filtration rate.
 Renal fibrosis is characterized by an excessive accumulation and deposition of extracellular matrix
components. (Fibrosis describes the development of fibrous connective tissue as a reparative response to
injury or damage).
 Uremic syndrome (also known as uremic syndrome) in patients with advanced chronic kidney disease
involves the accumulation in plasma of small-molecule uremic solutes and uremic toxins (also known as
uremic toxins), dysfunction of multiple organs. TRIAD: microangiopathy hemolytic anemia,
thrombocytopenia and acute renal damage.)
 Glomerular filtration rate (GFR) shows how well the kidneys are filtering. The estimated glomerular
filtration rate (eGFR) is a test that measures your level of kidney function and determines your stage of
kidney disease. (GFR= 90 to 120 mL/min/1.73 m2.)

CELLULITIS OF THE UPPER EXTREMITIES MORE ON GOUTY ARTHRITIS WITH PRURITUS, CKD SECONDARY TO
GOUTY NEPHROPATHY, HYPERTENSIVE CARDIOVASCULAR DISEASE.
NORMAL URIC ACID LEVEL= 3.5- 7.2 mg/dl
GFR= 90 to 120 mL/min/1.73 m2.
CREATININE= 0.6 to 1.1 mg/Dl
BUN= 5-20 mg/ dl

Stages of Chronic Kidney Disease

Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)