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Prevalence and Risk Factors for Urolithiasis in Primary Gout: Is a Reappraisal Needed?
JOSÉ ALVAREZ-NEMEGYEI, MARTHA MEDINA-ESCOBEDO, SALHA VILLANUEVA-JORGE, and JANITZIA VAZQUEZ-MELLADO
ABSTRACT.
Objective. To assess the prevalence and risk factors for urolithiasis in primary gout. Methods. One hundred forty patients with primary gout were studied. Urolithiasis was defined as a history of urolithiasis, or nephrolithiasis detected via ultrasonography in patients with no previous record of urolithiasis. Patient age, duration of gout, presence of tophi, obesity, alcoholism, high blood pressure, diabetes, hyperlipidemia, family history of urolithiasis, daily urine output, uricemia, urine pH, FeNa, FeUrate, urine pH/FeUrate index, and daily urine excretion of urate, sodium, calcium and potassium were compared between lithiasic and non-lithiasic subjects. Results. Fifty-five (39%; 95% CI 31–47) patients had urolithiasis, of which 37 (26%) were diagnosed by clinical history and 18 (13%) by ultrasonography. Patients with a silent kidney stone diagnosed by ultrasound tended to have shorter evolution of gout. Aside from urinary H+ ion concentration (lithiasic subjects 5.17 ± 3.9 µM/l; non-lithiasic subjects 3.80 ± 3.01 µM/l; p = 0.02), no difference was found between lithiasic and non-lithiasic subjects for the other variables studied. Conclusion. Ultrasonography increased the probability of diagnosing urolithiasis by 50%, meaning the prevalence of urolithiasis in gout is likely higher than previously reported. A higher urinary H+ ion concentration was the only variable associated with urolithiasis. Due to advances in diagnosis of gout and urolithiasis, as well as biochemical assays, the prevalence and risk factors for urolithiasis in gout require reassessment. (J Rheumatol 2005;32:2189-91) Key Indexing Terms:
GOUT
From the Unidad de Investigación en Epidemiología Clínica, HE CMN "Ignacio García Tellez," Instituto Mexicano del Seguro Social, Mérida, Yucatán; Laboratorio de Investigación, Hospital General "Agustin O'Horan," FUNSALUD Capítulo Peninsular-Secretaria de Salud, Mérida, Yucatán; and Servicio de Reumatología, Hospital General de México, Secretaría de Salud, Mexico City, México. Supported by grants from FOFOI/IMSS and FUNSALUD Capítulo Peninsular. J. Alvarez-Nemegyei, MSc, Researcher, Unidad de Investigación en Epidemiología Clínica, HE CMN "Ignacio García Tellez"; M. Medina-Escobedo, MSc, Researcher; S. Villanueva-Jorge, Staff, Laboratorio de Investigación, Hospital General "Agustin O'Horan"; J. Vazquez-Mellado, PhD, Researcher, Servicio de Reumatología, Hospital General de México. Address reprint requests to Dr. J. Alvarez-Nemegyei, Calle 57 #503 x 50 y 62, Col. Centro, 97000 Mérida, Yucatan, Mexico. E-mail: nemegyei@hotmail.com Accepted for publication June 24, 2005. |