A frequent occurrence of acute gouty attack induced by starting hemodialysis treatment in a patient with multiple large tophi and end-stage renal disease

Abstract

A 68-year-old man was admitted because of uremic symptoms in May 2006. He was diagnosed with gout after developing painful arthritis in the bilateral ankles and knee joints and hyperuricemia in 1964. Thereafter, he experienced podagra attacks once or twice over a five-year period. Renal function gradually worsened and he then developed uremia. On admission, he had tophus in a posterior site of the bilateral forearms, an inferior site of the bilateral knee joints and the left pinna, but there was no arthritis in any joint. He also demonstrated high levels of serum creatinine 6.9 mg/dL, and serum urate 10.5 mg/dL. A flare-up in the form of a gouty attack occurred soon after the 4th hemodialysis (HD) treatment and worsened in every subsequent HD treatment. A non-steroidal anti-inflammatory drug (NSAID) was ineffective for the gouty attacks ; however, oral administration of 0.5 mg colchicine just before HD effectively removed the symptoms and signs of gouty attack. Twelve months after initiation of HD, the tophus sizes were decreased. HD treatment removes a lot of urate from patients and can then result in a gouty attack through the breakage of urate crystals in the tophus and joints. Starting HD treatment for a patient with gout and end-stage renal disease may induce a gouty attack.