A 75-year-old man who had been treated with regular hemodialysis for 26 years developed polyarthritis. For the previous 2 months, he had often suffered from low-grade fever, bilateral shoulder pain, knee pain, anemia, and increased levels of inflammatory markers.Echo, CT, and MRI of the right shoulder showed cystic tumors with internal gas patterns. Similar images were detected in the left shoulder, bilateral knee joints, and hip joint by echo and MRI. Polyarthritis could not be distinguished clearly from suppurative arthritis. Calcium pyrophosphate dihydrate was detected in synovial fluid obtained by arthrocentesis of the left shoulder and knee. However, no bacteria were observed. Joint pain improved following joint immobilization and administration of NSAIDs, although the inflammatory markers remained elevated. A few months later, the symptoms of fever and joint pain recurred, with near ground-glass opacities (GGO) being observed on chest CT. These symptoms, cystic tumors, and abnormal shadow (GGO) improved rapidly following administration of prednisolone (PSL). The patient was diagnosed with atypical CPPD deposition disease, although the cause of his pulmonary disease could not be determined.

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Hyperuricemia (serum uric acid [SUA] ≧ 6.0mg/dl) and chronic kidney disease (CKD) defined as estimated glomerular filtration rate (eGFR)<60ml/min/1.73m² are common in the elderly, in whom the average of creatinine-based and cystatin C-based eGFR might be more accurate in assessing GFR. Associations between SUA and CKD diagnosed using average eGFR were investigated in 159 women aged 76 years. Subjects were divided into G1, G2, G3a and G3b corresponding to eGFR levels of ≥ 90, 60 to 89, 45 to 59 and 30 to 44ml/ min/1.73m². The respective prevalence was 14.5, 65.4, 14.5 and 5.7%. SUA and eGFR averaged 4.8 ± 1.0mg / dl and 71 ± 16ml / min / 1.73m², respectively. The prevalence of hyperuricemia was 13.8%. As the renal function declined, the prevalence of hyperuricemia increased; 0% in G1, 13.5% in G2, 21.7% in G3a and 33.3% in G3b (p=0.05) and SUA increased ; G1 : 4.4 ± 0.7, G2 : 4.7 ± 1.1,G3a:5.3 ± 1.0,G3b:5.7 ± 1.0mg/dl (p<0.001).As SUA increased, the prevalence of CKD also increased (SUA in mg/dl, 2-2.9 : 0%,3-3.9 : 6.9%, 4-4.9 : 16.9%, 5-5.9 : 27.9%, 6-6.9 : 31.6%, 7-7.9 : 66.7%, p=0.03). Increases in uric acid were associated with a higher prevalence of reduced renal function in community-living elderly women.

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Determinants of serum uric acid (SUA) levels in relation to kidney function have not been extensively studied in elderly Japanese people.
In this cross-sectional study, relationships of SUA with anthropometric indices, serum adipokines and liver enzymes, insulin-resistance related variables and inflammatory markers in relation to kidney function were examined in 159 community-dwelling elderly Japanese women.
By simple linear regression analysis, serum creatinine and cystatin C were positively and eGFR was inversely associated with SUA. It was also positively associated with BMI, percentage body fat, serum leptin and transthyretin. In addition, SUA showed positive associations with fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and serum gamma-glutamyltransferase (GGT). Further, log high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNF-α) were associated with SUA. Multiple regression analysis with SUA as a dependent variable showed that 27% of the variability of SUA can be accounted for by serum creatinine, GGT, leptin and transthyretin in order of increasing R².
In elderly Japanese non-obese women, high serum uric acid levels may represent a more favorable nutritional status and increased body fat in addition to poorer renal function. Associations with serum creatinine and GGT warrant further study.

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To date, there has been no epidemiological study of gout in Japanese children and adolescents. We conducted the first nationwide investigation on the prevalence and actual characteristics of gout in childhood and adolescence. A total of 512 hospitals with a pediatric department were enrolled. From the primary questionnaire, the number of both pediatric in- and out-patients, and the number of patients with gout in children and adolescents between 2008 and 2012 were obtained. When patients with gout were reported, their characteristics, including : age, gender, height, weight, previous and family histories, serum uric acid levels at gouty attack, the presence of underlying diseases, and treatment, were collected from the secondary questionnaire. There were 7 cases of gout, consisting of 6 boys and 1 girl. At gouty attack, the median age was 13.8 years (range: 12.7-18.3), and median serum uric acid level was 10.1mg/dL (range: 8.5-11.4). Six patients had underlying diseases such as Down's syndrome, renal hypoplasia, type 2 diabetes, and atrial septal defect. The remaining one patient was severely obese, with a high blood pressure and fatty liver. The present study clarified that the actual prevalence of gout in children and adolescents is extremely low, and that most patients have underlying diseases. When a pediatric patient with any underlying disease has high serum uric acid levels, it is necessary to pay attention to the possibility of gouty attack.

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[in Japanese]

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