Clinical Case Database / Category: Case Based Discussion

Gout: treatment and renal complications

Publication details

Dr RA Chapman, Dr F Birrell
Foundation Years Journal, volume 2, issue 10, p.423 (123Doc Education, London, December 2008)


A 68-year-old gentlemen presented to A&E with a 1-week history of being “off his legs”. On examination he was drowsy and febrile. He was admitted and treated for a urinary tract infection as he had a neutrophilia and the presence of blood and protein in his urine. In the past, he had been treated for hypertension, a stroke and non-specific c arthritis. Over the 5 days subsequent to admission, he developed oedema, severe hypoalbuminaemia and proteinuria and his C-reactive protein (CRP) rose to over 500. Blood cultures came back negative for organisms. It was noted that asymmetrical synovitis and bilateral knee and shoulder effusions had developed. Joint aspiration revealed negatively birefringent crystals and no organisms were seen or cultured. Tophi were noted on his pinnae and distal interphalangeal joints. A diagnosis of acute polyarticular gout with associated nephrotic syndrome was made. He received colchicine orally and underwent arthroscopy and lavage of his knees and shoulders. His symptoms and nephrotic syndrome resolved and he was discharged on regular allopurinol. He recovered well after a period of rehabilitation in a community hospital.

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Dr RA Chapman

Foundation Doctor
Northumbria Health Care Trust

Dr F Birrell

Consultant and Honorary Senior Lecturer in Rheumatology
Northumbria Health Care Trust and Newcastle University




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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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