Abnormally high levels of uric acid in the blood, known as hyperuricemia, and gout — once called the disease of kings — are linked with acute chronic kidney disease (CKD). In both conditions the innate immune system is stimulated, which in turn generates the release of inflammatory cytokines and chemokines, according to a thematic issue of The Open Urology & Nephrology Journal, titled “Current Perspectives in Hyperuricemia, Gout and the Kidney.”

The relationship between hyperuricemia, gout, and kidney disease has been the source of research for several years. There is sufficient epidemiological data suggesting the close association between gout and chronic kidney disease does not occur by chance alone. In almost all forms or acute and chronic renal disease — regardless of the etiology of the primary disease — there is a significant tubulointerstitial involvement.

The underlying anatomical changes are accompanied by a variety of functional tubular defects, the least of which are the effect on the sophisticated group of urate transporters contained in renal tubular cells that are critical for the maintenance of homeostasis.

Lead author William F. Finn from Chapel Hill, North Carolina discussed the interaction between different factors, particularly the critical role of the kidney in uric acid excretion and the possible impact of hyperuricemia in the progression of renal disease.

According to the author, the chronic inflammation associated with gout has a detrimental effect on the kidney, which happens as a consequence of the activation of the innate immune system through the stimulation of the NLRP3 inflammasome. This ultimately leads to the generation of interleukins and the release of cytokines and chemokines — and all of these factors interplaying between hyperuricemia, gout, and kidney disease.

With current updates in clinical guidelines for acute and chronic gout, and because there are particular considerations in certain patient populations, the author suggests integrating recommendations from the perspectives of the primary care physician, the nephrologist, and the rheumatologist.