A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain why a patient with gout is more likely to develop renal calculi.
Gout is a painful inflammatory arthritis characterized by the deposition of uric acid crystals in joints, commonly affecting the lower extremities. While the primary manifestation of gout is joint inflammation, it is important to recognize the potential systemic implications of this condition. One notable association is the increased likelihood of gout patients to develop renal calculi, also known as kidney stones. This essay aims to explore the underlying reasons behind this association and the contributing factors that make gout patients more prone to renal calculi formation.
Gout and renal calculi are both conditions associated with the accumulation of uric acid. In gout, the excess uric acid leads to the formation of monosodium urate crystals, which deposit in joints and trigger an inflammatory response. In renal calculi, uric acid crystals form and accumulate within the kidneys, leading to the development of stones.
Hyperuricemia: The hallmark of gout is hyperuricemia, an elevated level of uric acid in the blood. Hyperuricemia increases the concentration of uric acid in the kidneys, making it more likely for uric acid crystals to form and contribute to renal stone formation.
Decreased Urinary pH: Gout is often associated with an acidic urinary pH, which further promotes the formation of uric acid crystals. Acidic urine can result from increased production of uric acid or decreased excretion of hydrogen ions in the kidneys. The low pH environment favors the precipitation and accumulation of uric acid crystals, increasing the risk of renal calculi formation.
Impaired Renal Function: Gout can have deleterious effects on renal function over time. The chronic deposition of uric acid crystals in the kidneys can lead to interstitial inflammation and fibrosis, impairing the organ’s ability to filter and excrete waste products effectively. Reduced renal function can result in decreased urine volume, decreased pH regulation, and altered handling of uric acid, all of which contribute to the formation of renal calculi.
Diuretic Use: In the presented case, the patient is receiving hydrochlorothiazide (HCTZ), a diuretic commonly used to treat hypertension. Diuretics increase urine output, which can lead to a more concentrated urine and higher uric acid concentration. The combination of hyperuricemia and concentrated urine increases the risk of uric acid stone formation.
Lifestyle Factors: Obesity, as seen in this patient, is associated with an increased risk of both gout and renal calculi. Adipose tissue produces inflammatory cytokines that can exacerbate gout symptoms and promote renal stone formation. Additionally, dietary factors, such as a high intake of purine-rich foods (e.g., red meat, seafood) and excessive alcohol consumption, can contribute to hyperuricemia and increase the risk of renal calculi formation.
The association between gout and renal calculi stems from the shared underlying mechanisms related to uric acid metabolism. Factors such as hyperuricemia, acidic urine pH, impaired renal function, diuretic use, and lifestyle factors contribute to the increased likelihood of renal stone formation in gout patients. Recognizing this association is essential for healthcare providers to address both the joint symptoms of gout and the potential renal complications. Effective management strategies should include lifestyle modifications, pharmacological interventions, and regular monitoring of renal function to minimize the risk of renal calculi in patients with gout.
As a renowned provider of the best writing services, we have selected unique features which we offer to our customers as their guarantees that will make your user experience stress-free.
Unlike other companies, our money-back guarantee ensures the safety of our customers' money. For whatever reason, the customer may request a refund; our support team assesses the ground on which the refund is requested and processes it instantly. However, our customers are lucky as they have the least chances to experience this as we are always prepared to serve you with the best.
Plagiarism is the worst academic offense that is highly punishable by all educational institutions. It's for this reason that Peachy Tutors does not condone any plagiarism. We use advanced plagiarism detection software that ensures there are no chances of similarity on your papers.
Sometimes your professor may be a little bit stubborn and needs some changes made on your paper, or you might need some customization done. All at your service, we will work on your revision till you are satisfied with the quality of work. All for Free!
We take our client's confidentiality as our highest priority; thus, we never share our client's information with third parties. Our company uses the standard encryption technology to store data and only uses trusted payment gateways.
Anytime you order your paper with us, be assured of the paper quality. Our tutors are highly skilled in researching and writing quality content that is relevant to the paper instructions and presented professionally. This makes us the best in the industry as our tutors can handle any type of paper despite its complexity.
Recent Comments