Abstract
Objective
To review the etiology, treatment, and preventive strategies of hyperuricemia and gout in kidney transplant recipients.
Data Sources
Primary literature was obtained via Medline (1966-June 2003).
Study Selection and Data Extraction
Studies evaluating treatment and prevention of hyperuricemia and gout in kidney transplantation were considered for evaluation. English-language studies were selected for inclusion.
Data Synthesis
Approximately 14000 kidney transplantations were performed in the United States in 2003, and of those transplant recipients, nearly 13% will experience a new onset of gout. The prevalence of hyperuricemia is even greater. There are several mechanisms by which hyperuricemia and gout develop in kidney transplant recipients. Medication-induced hyperuricemia and renal dysfunction are 2 of the more common mechanisms. Prophylactic and treatment options include allopurinol, colchi cine, corticosteroids, and, if absolutely necessary, nonsteroidal anti-inflammatory drugs.
Conclusion
It is generally recommended to decide whether the risks of prophylactic therapy and treatment outweigh the benefits. Often, the risk of adverse events associated with agents to treat these ailments tends to outweigh the benefits; therefore, treatment is usually reserved for symptomatic episodes of acute gout. Practitioners must also decide if changes in immunosuppressive regimens may be of benefit on a patient-by-patient basis.
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