Gout in CKD — ESENeph MCQ

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EasyChronic Kidney DiseaseGout in CKDESENeph

A 65-year-old man with CKD G3b (eGFR 38 mL/min/1.73m2) presents with an acute gout flare. He has a history of peptic ulcer disease. NSAIDs are contraindicated. What is the most appropriate acute treatment?

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Correct answer: E — Colchicine (adjusted dose for renal function)

For acute gout in CKD where NSAIDs are contraindicated (peptic ulcer disease and CKD), Colchicine at a reduced dose (0.5 mg BD for CKD G3-4) is appropriate for acute flare treatment. Low-dose Prednisolone or intra-articular steroid injection are alternatives. Allopurinol and Febuxostat are urate-lowering therapies for prophylaxis, not acute treatment. Starting urate-lowering therapy during an acute flare can worsen symptoms.

Reference: NICE CG169 2022 – Gout; BSR 2017 – Gout Guideline; KDIGO 2024 – CKD