Epidemiological evidence suggests a close link between hyperuricemia and the high prevalence of hypertension and chronic kidney disease (CKD), suggesting that uric acid (UA) can be a precipitating factor for the progression of renal diseases. Clinical studies to investigate whether the UA-lowering therapy is renal protective appears to be of importance to prove this causal relationship. A recent meta- analysis revealed that UA-lowering therapies with the two forerunner xanthine oxidoreductase (XOR) inhibitors, allopurinol and febuxostat, may be beneficial for the progression of hypertension and CKD. In comparison, basic and clinical information of the renal benefit with a novel non-purine selective XOR inhibitor, topiroxostat (TPX), has not been fully investigated.

This review specifically highlights the currently available evidence on TPX that has been proven as efficacious as the other two formerly available XOR inhibitors in lowering serum UA levels as well as reducing urinary albumin excretion in patients with hyperuricemia or gout.

Objectives

Musculoskeletal ultrasonography (US) has been an established modality for the diagnosis of gout and possible evaluation of efficacy of urate-lowering therapy (ULT). To enhance its clinical importance and reliability, it would be important to know whether patient’s history and parameters of gout are related to monosodium urate deposition on US images.

Methods

We searched for eligible patients in our electronic patient database, based on the keywords of gout and hyperuricemia during the years 2007-2018. We then examined their medical history, uric acid excretion marker, serial data of serum uric acid (UA), renal function, dosage of ULT drugs, and US findings on gout flare. This study protocol was a retrospective descriptive one approved by our hospital ethical committee and carried out in accordance with the Declaration of Helsinki.

Results

A total of 72 patients (15 female, 57 male) were selected from our database search. US was timely undertaken for 28 of those patients (4 female, 24 male) who had experienced gout flare. Double contour sign (DCS) was found in 23 patients (4 female, 19 male; DCS group) and hyperechoic aggregate without DCS was shown in the other 5 patients (all male; non-DCS group). We compared duration after notice of hyperuricemia/gout, previous gout attack experience, initial serum uric acid (UA), fractional excretion of UA (FE_UA), BMI and eGFR for the groups. The duration after notice of hyperuricemia was significantly longer in the DCS group than non- DCS (DCS; 5.9 years, non- DCS; 1.8 years, p=0.0103). Moreover, the DCS group had experienced one or more previous gout attack episodes than the non-DCS group. No other clinical parameters were significantly different between the two groups. Presence of hyperechoic aggregate (HAG) findings was not related to any clinical parameter. Therefore, the processes of development of the two US findings seemed to be different from each other, although both DCS and HAG represented articular monosodium urate deposition.

Conclusion

DCS and /or HAG findings are frequently shown in US on a gouty attack and DCS may develop some years after the onset of hyperuricemia.

Kumamoto City was struck by two big earthquakes on April 14th and 16th, 2016. We conducted a patient questionnaire to assess changes in the treatment status and life and medication status of patients with gout and hyperuricemia at that time, and reported the impact of the disaster on these patients.

Of the 225 patients with gout and hyperuricemia who came to our hospital about 2 weeks after the main shock, we collected data on 142 persons who were able to undergo blood biochemistry tests. As a result, 70% of patients were able to maintain a uric acid level below 6 mg / dL.

A questionnaire survey was conducted on 70 of them randomly selected. With regard to meals, the food itself could be secured by stockpiling and purchase at stores, but there was a large amount of carbohydrates such as bread, rice balls, and lunchboxes to augment supplies and emergency food.

While fresh foods such as vegetables, meat and fish we can see that the intake of. In addition, there were many cases of weight gain due to the diet being biased towards instant foods and carbohydrates (so-called "earthquake-induced fattening"), and so it was considered necessary to draw attention to weight gain due to the excessive intake of carbohydrates. In addition, about 70% of people answered that there was no change in water intake, and so it is possible that they were not aware of a decrease in water intake because there was a water shortage and there were days when the temperature was high. And confirmation of water intake and awareness.