Pathology Of Gouty Nephropathy Uric acid crystals and urates are deposited in the kidney This leads to irritation and acute inflammationmore time more deposition This deposits act as ID: 933749
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Slide1
GOUTY NEPHROPATHY
Slide2Incidence
Slide3Slide4Pathology Of Gouty Nephropathy
Uric acid crystals and
urates
are deposited in the kidney.
This leads to irritation and acute
inflammation,more
time, more deposition.
This deposits act as
forgein
body granulomatous reaction ( macrophages,
lymphocytes,fibrpblasts
) forming white chalky nodules which is the ‘
TOPHUS’
Slide5Slide6Slide7Signs and symptoms
The chief sign is : Decrease production of the urine.
In a blood test : Rise in the creatinine level.
In a urine sample : Uric acid/creatinine Ratio > 1
Slide8TYPES OF GOUTY NEPHROPATHY
Slide9Acute gouty nephropathy
Overproduction of uric acid occurs primarily when tissue breakdown is accelerated.
Acute uric acid nephropathy is the term applied to the development of acute
oligoanuric
renal failure caused by renal tubular obstruction by
urate
and uric acid crystals. This is observed almost exclusively in the setting of malignancy, especially leukemia and lymphoma, in which rapid cell turnover or cell
lysis
occurs from chemotherapeutic agents or radiation therapy
Slide10Chronic Gouty Nephropathy
A widely accepted belief is that the overproduction of uric acid and the presence of
hyperuricemia
can cause acute kidney failure; however, whether chronic
hyperuricemia
independently results in chronic interstitial nephritis and progressive kidney failure is less clear.
In patients with chronic
hyperuricemia
and gout, early studies revealed
microtophi
formation in the renal medullary
interstitium
. These deposits were found to contain monosodium
urate
monohydrate and to be surrounded by a giant cell reaction. Thus, the theory was that
urate
deposition triggers a foreign body reaction and leads to chronic inflammation and fibrosis
.
Slide11Cases associated With gout
During
treatement
for
leukaemia
or lymphoma.
Other malignancies, such as metastatic breast cancer, lung cancer, or disseminated adenocarcinoma.
Seizures and pregnancy-related pre-
eclampsia
or
eclampsia
may also have an association with gouty nephropathy.
Moreover renal transplantation or longstanding use of a medication by the name of cyclosporine may also lead to gouty nephropathy.
Slide12General measures
Serum uric acid concentrations may be reduced with non-pharmacologic therapy :
Useful dietary and lifestyle changes include:
Weight reduction
Decrease alcohol ingestion
Decrease consumption of foods with a high purine content
Control of hyperlipidemia and hypertension.
However, these measures will probably not reduce serum uric acid levels to normal, which is the treatment goal for the prevention of acute gout attacks.
Symptomatic
hyperuricemia
usually requires medication.
Slide13Treatment of acute gouty nephropathy
Cholchicine
and
demicholine
( specific anti-inflammatory drugs)
NSAIDS as
indomethacine
(in patients who cannot tolerate colchicine )
Glucocorticoids and ACTH (If NSAIDS are ineffective)
Slide14Slide15Slide16Slide17Treatment of chronic gouty nephropathy (prophylactic treatment)
Uricosuric
drugs
:
probenicid
,
sulphinpyrazone,benzbromarone
, aspirin
Uricostatic
drugs
:
allopurinol,Fuboxostat
Slide18Thank YoU