Category Archives: Gout

Dear Sir, I read your post “Let’s Drink to Kidney Health (Literally)!” In Huffpost. Thank you for this valuable post. I am from Almora, India. I want to ask a general problem of uric acid which is now very common here in my town. My father and elder brother have uric acid problem. This problem is among so many people I know. The temperature of my place is around 20-25 in summer and -2 – 5 in winters. How this problem can be controlled or cured with food and exercises? Which food should be included and which should be excluded? I will share to every needy person so that they can get benefit out of it. :) Thank you

Uric acid problems can consist of acute and chronic gouty arthritis in the joints (especially in the feet and ankles). Uric acid can also cause kidney stones and can cause chronic damage to the kidneys in the form of gouty … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, Gout, Kidney Stones, Kidney-Related Health Questions

I had a episode of gout in my left foot and left shin. It was a sharp pain that lasted more than a few seconds. Then suddenly my right foot started to swell. My left foot didn’t swell. The right foot didn’t have the gout pain and it swelled. Is this common? How do I get the swelling down? Does this affect kidney function?

I am unable to explain the swelling. Gout does not cause pain for just a few seconds. Gout causes pain that is very intense and usually lasts for hours to days. I suggest that you see your primary care physician … Continue reading

Posted in Ask the Doctor, Gout, Kidney-Related Health Questions

I have been recently diagnosed with mild tubular atrophy and interstitial fibrosis (and stage 3 CKD) via a needle biopsy. The etiology is unknown- my nephrologist suspects its due to medication side effects since I do not have the many other conditions which may cause it. I was told to avoid certain medications like PPIs and NSAIDs. I am concerned that there is not a definite cause given. Knowing a specific cause can help me plan my lifestyle to hopefully avoid whatever has caused/contributed to it. I’d like to know if further tests might better define the cause. I am wondering if I should get a second opinion or what I should request of my current nephrologist. Any feedback is appreciated.

Interstitial nephritis is an uncommon cause of chronic kidney disease (CKD). A kidney biopsy is the definitive way to make a kidney diagnosis, so you have had the definitive test for kidney disease. There are many causes of interstitial nephritis, … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Gout, Kidney Biopsy, Kidney-Related Health Questions

Sir, this is pertaining to my father, who is 66 yrs old and has been diabetic since 1996. His present Creatinine level is 4.8. He has been advised to take the below mentioned medicines. Are the prescribed medicines okay for my father? His liquid intake in a day is restricted to 1 liter and no salt in food. Kindly advise. Here is a list of his medications: 1)ARKAMIN 0.2 mg 2)NICARDIA R 10 mg 3)CARVEDILOL 25 mg 4)SOBISIS 500 mg 5)FEBUXOSTAT 80 mg 6)PHOSTAT 667 mg 7)KETOSTERIL 8)URIMAX 0.4 mg 9)ANFOE 4000 10)LUPIHEME 12 mg 11)RENERVE 12)NOVARAPID 13)LANTUS

The medications that you describe are common medications used in patients with diabetes, gout, and chronic kidney disease (CKD). Some of the medications are used to treat anemia in patients with CKD. I am unable to recommend doses and medication … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Diabetes, Gout, Kidney-Related Health Questions

I have Stg 4 CKD; a transplant is approx 4 months away. However, I have recently had bouts of gout in my lower extremities. Took prednisone, but it remains, and periodically flares up. Is it safe to take tart cherry and celery seed to bring Uric acid levels down? Those levels currently at 14.5 to 16. Watching diet doesn’t seem to help. Thanks.

There are medications such as Febuxostat (Uloric) and Allopurinol (Zyloprim) that lower the serum uric acid levels and effectively treat gout. Use of these agents with low dose colchicine can be very effective in patients with gout and chronic kidney … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Gout, Kidney-Related Health Questions, Nephrologist

Dr, my father has undergone kidney disease as he had gotten his blood test checked and found out 3.3 level of creatinine and 46 level of urea. We got health care from a nephrologist and he suggested Zurig 40mg, Ferrocite 500mg and cap of vitamin D. Please comment

I am unable to make a specific diagnosis based on the information that you present.  The medications that you mention are commonly used in patients with chronic kidney disease (CKD).  The use of a medication to treat gout (Zurig) and … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Gout, Kidney-Related Health Questions

Hello doctor, My father has been on dialysis for almost 2 years. He has a major problem of high fever and pain + swelling in hand joint and legs. We went to many doctors in your country but we didn’t find a solution. Please help my father. He is suffering from very painful time.

I am not able to make a specific diagnosis based on the information that you present. There are many possibilities for hand and joint pains including gout, pseudogout, amyloidosis related to dialysis, secondary hyperparathyroidism, infection, and other inflammatory types of … Continue reading

Posted in Ask the Doctor, Dialysis, Gout, Kidney-Related Health Questions, Laboratory Testing

Hello. I’m 24 years old. My doctor did quite a bit of blood work on me to eliminate some ankle pain. Come to find out, my GFR is 41.45. I don’t know if I should be concerned. He doesn’t really think there is anything wrong with it. Can you tell me if this is a bad number?

The normal for an estimated glomerular filtration rate (eGFR) is greater than 60 milliliters per minute per 1.73 meters squared. The number that you mention is 41.45.  I suggest you discuss this laboratory result with your physician.

Posted in Ask the Doctor, GFR, Gout, Kidney-Related Health Questions, Laboratory Testing

Honorable Dr. Leslie Spry M.D., FACP My wife done Renal Biopsy on 31st July 2017 report as under. Please medicine. Gross Description: Two light brown needle cores of soft tissue, the larger measuring 1.1 x 0.1 cm and the smaller, 0.9 x 0.1 cm. Total tissue processed. Microscopic Description: Renal cortical biopsy containing up to twenty-one(21) glomeruli, all of which are normocellular with GBM of normal thickness. The blood vessels are more or less within normal limited. The interstitium shows small faci of moderate non-specific chronic inflammation with mild tubular atrophy limited to these areas. Immunofluorescence: Immunoflurescence studies for IgG, IgM, IgA, C3c and C1q were negative. Diagnosis: Renal biopsy : Appearances consistent with non-specific mild chronic tubulointerstitial nephritis. Focal segmental glomerulosclerosis cannot be excluded. Here advise Tablet Deltacortil 5mg 6+0+6 and Cap.

Interstitial nephritis is a relatively uncommon kidney disease that can be due to infection of the kidney and can be seen in chronic gout.  It can also be an allergic reaction in the kidney.  I am unable to recommend treatment … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Gout, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Treatments

Hi- History: 60 y.o female Dx’d with Crohn’s 2010. Put on Mesalamine. Developed Interstitial nephrites dx’d in 2011. Taken off Mesalamine upon which I went into Crohn’s remission for 2 years. My Creatinine which was up to 1.2 returned to .89. In 2013 Crohn’s returned. I was being treated with Infliximab for Crohn’s and then after the 13th infusion noticed an ammonia taste in my mouth. That was the only symptom. A renal panel drawn prior to the next infusion revealed a Creat. over 3 and GFR of 15, I’d like to know whether you think the following biopsy points to Crohn’s as the cause or Infliximab as the cause of this renal injury. Also, was I more likely to have interstitial nephritis again since I had it previously? Thanks. KIDNEY BIOPSY (NEEDLE) SEVERE ACUTE AND CHRONIC INTERSTITIAL NEPHRITIS, WITH AN ISOLATED NON-NECROTIZING GRANULOMA (SEE NOTE) NO EVIDENCE OF IMMUNE COMPLEX-MEDIATED OR PARAPROTEIN DEPOSITION DISEASE; CRITERIA FOR IgG4 RELATED DISEASE ARE NOT MET IN THIS SAMPLE MODERATE CHRONIC CHANGES OF THE PARENCHYMA, INCLUDING: – GLOBAL GLOMERULOSCLEROSIS (10% OF GLOMERULI) – MODERATE TUBULAR ATROPHY AND INTERSTITIAL FIBROSIS – SEVERE ARTERIAL AND ARTERIOLAR SCLEROSIS NOTE: The biopsy reveals widespread plasma cell-rich interstitial inflammation, with a focal small non-necrotizing granuloma. This type of injury is most commonly related to a hypersensitivity reaction to drugs (sulfonamides, beta-lactam and other antibiotics, anti-viral agents, diuretics, NSAIDs, cimetidine and H2-blockers, and a long list of miscellaneous drugs). Other causes of chronic active interstitial nephritis include severe various infectious processes, metabolic diseases (gout and hyperuricemic conditions), toxic processes (lithium, lead, and other heavy metals), aristolochic acid nephropathy (Chinese herb nephropathy), physical causes (obstruction and radiation injury), and other conditions (Balkan nephropathy, sarcoidosis, “idiopathic” interstitial nephritis). For most of these conditions there are no specific or even characteristic morphological findings, and the disease process can only be diagnosed by correlating the biopsy findings and the history of the use or exposure to certain drugs or substances. There is no evidence of immune complex or paraprotein deposition. IgG4 related disease is unlikely, given the results of immunohistochemistry studies (see results below). MICROSCOPIC DESCRIPTION: Sections of formalin-fixed, paraffin embedded tissue were evaluated using H&E, PAS, JMS, and trichrome stains. An H&E-stained frozen section taken from the tissue allocated for immunofluorescence microscopy and semi-thin toluidine blue-stained epoxy sections of the tissue processed for electron microscopy were also evaluated using light microscopy. The sample consists of 57 glomeruli (LM-48; IF-5; EM-4), of which 6 are globally sclerosed and several glomeruli appear hypoperfused. The non-sclerosed glomeruli are of normal size and reveal normal thickness of the glomerular capillary loops. Significant endocapillary proliferation or cellular crescents are not seen in the glomeruli. The mesangium is not significantly expanded. The interstitium reveals large areas of intense inflammation, associated with mild edema and focal tubulitis. The infiltrates are composed of lymphocytes and many plasma cells, several eosinophils and scattered neutrophils. Isolated foci of Tamm-Horsfall protein inspissation are present in the interstitium. A focal small non-necrotizing granuloma is noted, with epithelioid cells, lymphocytes, and an isolated multinucleated giant cell. In less involved areas, tubules reveal normal cellular details. In inflamed areas, tubules reveal tubulitis and focal degenerative changes. Several tubules also contain necrotic cellular debris. Several PAS-positive hyaline casts are also noted. The sample shows moderate tubular atrophy and interstitial fibrosis. Arteries and arterioles show severe sclerosis. Arterioles also show focal hyaline degeneration. IMMUNOHISTOCHEMISTRY RESULTS: The staining for CD138, IgG4, and IgG were performed using immunoperoxidase technique. Numerous CD138-positive plasma cells were identified, but only isolated cells stain for IgG4. The positive control slide and the patient’s negative non-immune control slide (normal serum) show appropriate reactivity. The immunohistochemical tests performed at Brigham and Women’s Hospital were developed and their performance characteristics determined by the Immunohistochemistry Laboratories in the Department of Pathology at BWH. They have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. IMMUNOFLUORESCENCE MICROSCOPY: KIDNEY BIOPSY #: E15-926 The sections of the sample submitted for immunofluorescence studies were incubated with antibodies specific for the heavy chains of IgG, IgA, and IgM, for kappa and lambda light chains, fibrin, albumin, and complement components C3 and C1q. The sample contains 5 glomeruli. There is 1 globally sclerosed glomerulus. No significant immune deposits are seen in the glomeruli. IgM stain shows dusty reactivity in the background of the tissue; there is also fine granular reactivity for IgM (trace) along the glomerular capillary loops. Dull reactivity with fibrin is noted along the glomerular capillary loops. Tubular basement membranes show focal fine granular deposition of C3 (trace). Tubules contain several intraluminal casts reactive for polyclonal IgA. The interstitium reveals scattered fibrin deposits. Some interstitial inflammatory cells are positive for kappa or lambda light chains. The vessels exhibit focal deposition of C3. There is no difference in reactivity between kappa and lambda light chains in the glomeruli, tubular casts or background of the tissue. The immunofluorescence microscopy tests performed at Brigham and Women’s Hospital were developed and their performance characteristics determined by the Immunohistochemistry Laboratories in the Department of Pathology at BWH. They have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. ELECTRON MICROSCOPY: KIDNEY BIOPSY #: E15-926 Blocks: 1 Block examined: 1 thick section; 1 thin section. The sample submitted for electron microscopy examination contains 3 glomeruli; 2 glomeruli are examined ultrastructurally. The glomerular visceral epithelial cells reveal moderate effacement of their foot processes. The glomerular basement membranes are segmentally attenuated. Morphometric analysis was performed on 105 sites, using orthogonal intercept method. The harmonic mean of the glomerular basement membrane thickness is 274 nm. The subendothelial space of the basement membrane is segmentally expanded by electron-lucent fluffy material in a few capillaries; a new layer of basement membrane material is formed under the displaced endothelium (double contours). The endothelial cells show no significant changes. The mesangium reveals normal cellular elements and a normal amount of matrix. No electron dense deposits are present in the mesangium. CLINICAL DATA: History: A 60-year-old female with Crohn’s disease who presents with AKI. BUN 44, Cr 2.79 (baseline 0.89 in 2/2014; peak 3.24 on 7/18/15), Alb 4.0, HbA1c 5.4, C3 86, C4 15, free kappa LC/lambda LC ratio 2.45, negative hepatitis B/C, negative SPEP, urine sediment WBC 4/hpf, UA blood negative, proteinuria 0.14 g/gCr. TISSUE SUBMITTED: A/1. LM. B/2. IF. C/3. EM.

I am not able to give a medical opinion without performing a complete history and physical examination.  I suggest that you discuss your concerns with your nephrologist.  The biopsy diagnosis appears to be an interstitial nephritis but I’m not sure … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Gout, Herbal Supplements in Kidney Disease/Failure, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments