Gout in renal transplant recipients

SUMMARY: Aims:  The aims of the present audit were to determine the prevalence of gout in renal transplant recipients in Canterbury, New Zealand, to identify risk factors for gout, and to assess the range of treatments used, their efficacy and complications. In addition, the authors wished to assess the impact of post‐renal transplant gout on the patient. Methods:  Patients with post‐transplantation gout were identified from the Christchurch Hospital Nephrology database. For each patient with gout a post‐renal transplantation recipient without gout post transplant was found matched for age, sex and date of transplant. Case notes were audited and patients interviewed. Results:  In total, 47/202 (23%) living renal transplant recipients had gout post transplant. Those patients with gout were more likely to be taking a loop diuretic (68% vs 34%, P  < 0.001), to have a higher serum urate and impaired renal function and to have had gout prior to the transplant. Of those patients who developed gout post transplant 70% had an attack at least every 3 months. Of those who returned to work post transplant 48% required time off work because of gout. Conclusion:  Gout is an important problem in the post‐transplant population causing significant morbidity and time off work. Diuretics, impaired renal function, gout prior to transplantation and hyperuricaemia are important risk factors. The need for diuretic therapy should be kept under review in these patients. Hypouricaemic therapy should be considered early in those who develop gout post renal transplantation. Further studies are required to determine whether treatment for asymptomatic hyperuricaemia is justified.