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I was diagnosed with IgA nephropathy 20 years ago when I was 40, and with gout about four years ago. My nephrologist would like to lower my uric acid levels but I don't tolerate allopurinol well—I have tried it twice for about two weeks each time but the headaches and upset stomach leave me feeling lousy. And from what I read, the lower doses of allopurinol that are acceptable for kidney patients might reduce uric acid levels slightly for me but may not actually prevent gout attacks. So what about febuxostat (Uloric)? Does anyone have experience with that or other options? My kidney disease also means I can't take NSAID drugs so I use prednisone (very successfully) when I have an attack. However, the long term reduction of uric adic is important to my health. Thoughts?
Grandma,
I don't think anyone here has given febuxostat a try but you certainly should consider it if your nephropathy is MILD. It's not recommended for people with severe kidney disease and it's not very good for underexcreters.
You should probably have a test to find out if you are an overproducer of uric acid or an underexcreter. But your problem is unique and even a drug like probenecid can harm the kidneys. I think you just need to follow the advice of the very best nephrologist that you can find.
Even colchicine is problemmatical with damaged kidneys.
And of course gout itself is a kidney destroyer.
How bad are your kidneys? Are you hypertensive and leaking protein? If you ARE hypertensive, losartan is a good choice. If your cholesterol is up, Lipitor is a good choice becasue both are uricosuric.
The one thing you have in your favor is that prednisone is also good for IgA nephropathy…I have trouble getting my tongue around that word.
Zip2play–thanks for your prompt and helpful response. I am mildly hypertensive–I take 5 mg of lisinopril daily. Protein is fairly normal, creatinine 1.51 mg/dL as of last February (slightly up over the years but going slowly so far). Mild chronic hematuria.
Uric acid 9.2 mg at last test but that was at the start of a gout attack; prior tests were 7.2 and 7.5. Highish LDL but not yet on statins.
One further issue–when I was on hormone replacement therapy for wicked (disabling) hot flashes, I had two years with no gout. When I went off the HRT, gout returned, and hot flashes worse than ever, so now I am back on HRT. Tradeoffs here are scary but I am so much healthier on a dialy basis when taking HRT that I am tempted to continue another two years. Too many choices and most of them wrong in one way or another! Thanks for caring–wonderful to have someone to talk to about all of this! MG
HRT is fairly well known to help with gout – from memory, it is thought that estrogen keeps the uric acid down. (I’ve made a note to do a proper summary of the research)
You don’t mention the dose of allopurinol that is giving you problems.
Many people with reactions to allopurinol can be desensitized with gradually increasing a low dose.
Maybe a combination of HRT for a bit longer, together with very gradually increasing allopurinol might do the trick.
Discuss these options, together with zip2plays advice about losartan and lipitor, with your doctor. It may well be that you can find a good combination that will keep your uric acid levels down and wean you off the HRT.
I think a closely monitored trial with febuxostat is in your cards. You want that uric acid a lot lower than the 7 level.
Yes of course, go with the HRT. There's a good reason that ovulating women have uric acid levels a full 2 points lower than men and I don't think it has much to do with high heels.
(Ask your doctor what he thinks about probenecid and your kidneys.)
GoutPal–in response to your question, the dose of allopurinol I was given was VERY low already–100 mg. But I will certainly explore the losartan and lipitor options–I hate taking any medications but the literature on IgA nephropathy is clear that high uric acid levels are indicative of a poor prognosis with kidneys, so I want to do whatever I can for both the kidneys and gout. Thanks to you and zip2play for EXCELLENT suggestions–your support makes me feel MUCH less alone in all this. MG
I have IGA nephropethy and have just been diagnosed with the Gout. I want to know how this is related to my kidney disease. My nephrologist hasn't called me back yet this am to tell me to come in or what he thinks but I think this is related to my kidney disease. I had gastric bypass to reduce my weight from 330 and I'm 6'5″…I now weigh 193 after 7 months out from the surgery. I lost too fast because I had a gastric ulcer and didn't know it…I was in ICU in March because I fell out from the loss of blood and my wife rushed me to the hospital and I had already lost 4 units of blood and received 2 emergency surgeries and a full transfusion before finally recovering. I had thought the gastric bypass would help my kidney's more and it has cured my high blood pressure problem caused by the kidney disease…I don't even have to take high blood pressure meds or the kidney meds they had me taking…but this gout is very painful and I know my kidney's are acting up because of the odor and color of the urine. Just wanted to know the relation between IGA and GOUT
There are doubts about the exact nature of the link between IgA nephropathy and gout. Some suggest that IgA nephropathy, where you get Iga protein deposits in the kidney, affects the way the kidney handles uric acid, leading to raised uric acid levels in the blood. Others believe that uric acid crystal deposits in the kidney cause Iga protein to build-up.
In practical terms, management requires the skills of both the nephrologist, and rheumatologist. The goal is to reduce your uric acid level below 6mg/dL. If you are not on any other medication, allopurinol is the obvious choice, and as that situation is quite straightforward, I would expect the nephrologist to be able to manage this. If you are on other medications, or if there are other complications, the nephrologist and rheumatologist may need to work together to ennsure that treatments do not conflict.
Whatever happens, I repeat, you must get your uric acid below 6mg/dL and get regular tests to keep it there. Some pain relief may be necessary for a few months until all uric acid crystals have dissolved.
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