RENAL DISEASE IN PRIMARY GOUT

It is suggested that the development of vascular nephrosclerosis at an early stage in the recognition of gouty individuals be considered in relation to their particular tendency to develop other manifestations of occlusive arterial disease.

Abstract

A study has been made of renal disease in 53 gouty patients. Renal function was investigated in detail in 27 of these patients and a routine and enzyme histochemical study was made in 25 by means of percutaneous needle biopsy of the kidney. The clinical and investigational findings are compared with those drawn from a review of the literature. Hypertension, urolithiasis, and obesity were particularly common. Renal insufficiency was present in 11 (41 per cent.) of the 27 patients investigated in detail, even after consideration of the natural decline in renal function with age, but was mild in all but two patients with coincident diabetic glomerulosclerosis. The results did not indicate any disparity between the loss of glomerular function and that of tubular function, and the development of renal insufficiency was more related to increasing age than to the gouty process itself. Renal biopsy histology demonstrated vascular nephrosclerosis in 21 of 23 non-diabetic gouty patients, this incidence and severity being twice that found in a oontrol histological study of 100 non-gouty autopsy subjects of a comparable age range. No specific glomerular lesion was found. Chronio pyelonephritis did not play an early role in the production of renal damage. Dilatation of oortical tubules, associated on occasions with a focal lymphocytio interstitial infiltrate, was found in only six patients of whom none had any bacteriological evidence of pyelonephritis but three had evidence of urolithiasis. These tubular and interstitial changes appear to be non-infective and could be due either to simple ischaemia of vascular origin or to obstruction of the distal nephron or extra-renal urinary tract by uric acid crystal deposits. Enzyme histochemical techniques did not provide any evidence of tubular damage at an earlier stage than was detectable by routine histological stains. It is suggested that the development of vascular nephrosclerosis at an early stage in the recognition of gouty individuals be considered in relation to their particular tendency to develop other manifestations of occlusive arterial disease.