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Tacrolimus Hyperuricaemia Gout — ESENeph MCQ

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EasyTransplantationTacrolimus Hyperuricaemia GoutESENeph

A kidney transplant recipient 1 year post-transplant on Tacrolimus has consistently elevated uric acid (580 umol/L) and develops his first episode of gout. His Tacrolimus trough is 6 ng/mL. What is the relationship between Tacrolimus and hyperuricaemia?

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Correct answer: D — Tacrolimus causes hyperuricaemia through reduced renal urate excretion – this is a well-recognised side effect contributing to post-transplant gout

Both Tacrolimus and Ciclosporin cause hyperuricaemia, though the mechanism differs slightly. Tacrolimus reduces renal tubular urate excretion. Ciclosporin does the same but also has direct effects on urate handling. Post-transplant hyperuricaemia occurs in 50-80% of CNI-treated patients, and gout develops in 5-15%. Treatment follows standard gout guidelines with adjustments: Allopurinol is first-line ULT (start low, titrate), but the Allopurinol-Azathioprine interaction must be avoided (if on Azathioprine). Colchicine requires CNI dose awareness (potential interaction through P-glycoprotein).

Reference: KDIGO 2009 – Transplant; BNF – Tacrolimus ADRs