النقرس مع القصور الكلوي الشديد (eGFR أقل من 30 مل/دقيقة): ماذا يُفعل حين لم يُحقق علاج النوبة الحادة الحل الكامل

References

DOI: 10.1136/annrheumdis-2016-209707

• Colchicine and NSAIDs should be avoided in patients with severe renal impairment.
• The safe use of colchicine in patients with severe renal impairment (GFR <30 mL/min) has not been established.
• Because colchicine clearance is decreased in patients with severe renal impairment, the group considered that it should be avoided in these patients, because a reduced dosage might be a source of therapeutic misuse.
• In patients with renal impairment, the allopurinol maximum dosage should be adjusted to creatinine clearance.
• Every person with gout should receive advice regarding lifestyle: weight loss if appropriate and avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals and excessive intake of meat and seafood.
• Low-fat dairy products should be encouraged.
• Regular exercise should be advised.
• For patients on ULT, SUA level should be monitored and maintained to <6 mg/dL (360 mmol/L).
• A lower SUA target (<5 mg/dL; 300 mmol/L) to facilitate faster dissolution of crystals is recommended for patients with severe gout (tophi, chronic arthropathy, frequent attacks) until total crystal dissolution and resolution of gout.
• SUA <6 mg/dL (360 mmol/L) should be maintained lifelong.