Mr. Wang has been suffering from gout for more than 20 years. No matter how his family and friends persuade him, he does not take uric acid-lowering or uric acid drugs. He only takes some medicine when gout recurs. Over time, many joints of Mr. Wang’s limbs had tophi deposits and the joints were severely deformed. More than a month ago, he often felt nauseous and fatigued. Only then did he realize the seriousness of the matter and came to our hospital for treatment. After examination, it was found that his creatinine was as high as 478 (59～104μmol/L for normal men), uric acid was more than double the ideal range, and hemoglobin was only 1/3 of normal. Combined with the medical history, we believe that he is a typical end-stage renal disease (commonly known as “uremia”) caused by gout.
Uremia refers to the toxicity caused by the human body’s inability to produce urine through the kidneys, and the inability to excrete waste products and excessive water from the body’s metabolism. Although chronic glomerulonephritis is still the largest kidney disease in my country, it is not uncommon for patients with renal failure (scientific name gouty nephropathy) or even uremia due to gout in recent years! It is estimated that about 16,000 people enter uremia due to gout every day in the country, and thousands die from gouty nephropathy.
What is the relationship between uremia and gout? It is clinically believed that high uric acid is an independent risk factor for inducing nephropathy, because-
uric acid deposition induces calculus gout, like diabetes and hypertension, which is a metabolic disease and requires long-term medication (uric acid reduction). If the treatment is not standardized, the medication should be stopped. Stop, or eat if it hurts, or not eat if it doesn’t hurt, it is easy to induce tophi. Tophi is a crystal formed by the accumulation of excess blood uric acid in the body in the form of sodium salt (sodium urate crystals). It not only deposits in joints, soft tissues, cartilage, but also in the renal tubules. This is why many people with a history of gout for many years The cause of kidney stones in patients. Our kidney is like a shower head. Once the stones are too large or too large, the renal tubules may be blocked, which will affect kidney function.
Chronic Gouty Nephropathy The kidney is the largest “filter” of the human body. Its main responsibility is to clean up the body’s garbage. When the uric acid in the body of gout patients is at a high level for a long time, in order to excrete these excess uric acid from the body, the kidney has to do High-load “work”, over time, the patient’s kidney function will decline.
Most gout patients with drug-induced nephropathy need to take medicine for a long time. As far as the kidneys are concerned, the most feared is to reduce, stop, or even take medicine, especially painkillers, without authorization. Certain analgesics themselves are a kind of drugs that can easily cause kidney damage, which often leads to kidney ischemia and damage to the renal interstitium. Indiscriminate medication will undoubtedly increase this risk. Clinically, acute renal failure may be induced by eating a painkiller indiscriminately.
Therefore, gout patients must be aware of the prevention of gout and take effective measures to reduce the recurrence of gout. To protect the kidneys, it is recommended to start with the following points-
1. Drink plenty of water, at least 2000 ml per day, which will help the excretion of uric acid. At the same time, it should be noted that patients with gout should not drink alcohol. Alcohol is a catalyst for uric acid, which will increase the level of uric acid in the body and hinder the excretion of uric acid. According to foreign studies, women who drink regularly have a three times higher risk of gout than those who only drink twice a week; for men, people who drink regularly have a higher risk of gout than those who do not drink. Out 2 times.
2. Control the level of uric acid. On the one hand, take uric acid-lowering drugs under the guidance of a doctor. Do not stop, reduce, or even take drugs without authorization; on the other hand, control the intake of purines. When the body cannot metabolize excessive purines, It will cause a disorder of purine metabolism-purine will become blood uric acid after oxidation in the human body. Therefore, the total calories should be controlled in the diet and the large intake of high-purine foods (fat, seafood, animal organs, etc.) should be restricted.
3. People with high uric acid must not hold back urine. Holding the urine will cause uric acid to accumulate in the body without time to metabolize, and then form crystal stones, damage kidney health, induce kidney disease, and increase the risk of chronic renal failure.
4. Regular review to understand kidney function. Regularly review the renal function according to the specific situation, and do kidney B-ultrasound or CT examinations if necessary. If the renal function is unstable, it is recommended to check once every 2 to 3 months or half a year, and go to a specialist outpatient clinic for treatment if necessary; if the result is normal, it can be extended to once a year.
