What are the ACR treatment guidelines for gout in patients with renal disease?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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In patients with gout who have moderate to severe kidney disease, ACR guidelines recommend xanthine oxidase inhibitor therapy with either allopurinol or febuxostat as the first-line pharmacologic approach. Probenecid can be used in patients who have contraindications to or are intolerant of at least 1 of those first-line agents, or it may be combined with a xanthine oxidase inhibitor if the inhibitor does not lower uric acid sufficiently. [125, 127]  Probenecid could also be used for those patients who consider the risks of xanthine oxidase inhibitors to be too high.

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