Gout with kidney pain on allopurinol

[A- Lo]

Hello! I hope it’s ok to start a new thread already. This board is wonderfully helpful, thank you Keith!!

I am a new gout sufferer and getting it under control over the last 6 weeks and have just started reading actively here but already have picked up on a lot of the great insights. Have lost 20 of my 170 lbs and dieting well, in addition to 100 mg allopurinol. I’m also drinking more than I used to, as I didn’t drink nearly enough water prior to all this. I turn 45 this weekend.

My kidneys have had a dull aching pain that I’m worried about. Is it from drinking too much water perhaps? I probably only drink 1.5-2 L per day tops…I find the more I drink, the more it hurts, but I know I need to hydrate more than I used to. Has anyone else found this as a side effect of drinking too much water, OR a side effect from allopurinol? Thanks!

[Keith Taylor]

I always shudder a little when I get asked about kidneys. Because personally, if I had any persistent kidney pain, I’d go straight to my doctor.

Anyway, in my gout studies, I’ve learned a little bit about drinking water and kidneys.

First, it’s a mistake to think that only plain drinking water is important. There is water in everything we eat and drink. It’s used up all over the body. The kidneys try to regulate supply so there’s always enough for everything we need. But, that changes all the time. Temperature and activity change the amount of fluid we need. So, there’s never a fixed amount daily.

We should drink regularly throughout the day. Then, check urine color. It should be pale straw colored. Not completely clear, or too dark. If it’s too pale, it’s an indication that you are drinking too much. That can overstrain the kidneys.

The other important thing I’ve learned about kidneys is blood tests. Everyone should have kidney function tests at least once a year. That lets your doctor see what is usual for you. Then, if significant changes happen, your doctor can investigate. Tests are more important when you are lowering uric acid. It doesn’t matter which method you use. Allopurinol is most common. But all uric acid lowering treatment needs regular monitoring. That applies to herbal medicines and diet, just as much as drugs such as allopurinol, Uloric, or any others. Though I say at least once a year, at the start of treatment it should be once a month. Then, as uric acid stabilizes, you can extend the time between tests. Always insist on liver function and kidney function tests when you get uric acid tests.

Finally, coffee and milk are better than water at encouraging uric acid excretion. From a calorie point of view, skim milk is best. Plain water is still good. But, variety is much nicer.

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[A- Lo]

Thanks as always, Keith. I think I am drinking plenty and mixing it with fruit juices etc (cherry in particular 😉 and not drinking too much, the pain is only when I likely drink too much, so is not persistent. I have a dr’s appt coming in 10 days or so, so will ask for those tests, which he did not yet give me an order for.

[Lowell Andrew F.]

So it’s been 8 weeks or so since diagnosed, I lowered my uric acid level to 4.9 (from 6.4 if I remember correctly, although it was 7.1 last year with no pain or ill effects)!

However…

I celebrated with a beer. One microbrew 16 oz IPA full of goodness. I would think that would be ok. Maybe not at this stage. I wonder if we are more sensitive to quick spikes in uric acid levels after we’ve been through all this? My understanding, though, is that the levels change slowly. Last night after the beer I had a lot of pain in my hands/feet, areas I hadn’t even felt it in before. So, perhaps it was foolish, and I would not recommend it, because as you all know, it’s not worth “experimenting” with pain, and doesn’t really end up helping the celebration. Now, I know that eventually on allopurinol we should be able to have an occasional beer, but I really think this one is my trigger and may have caused it in the first place. I’ll give it some time and see how I feel in a couple days, though.
I can also relate to Jill’s recent post as I to have had a sharp pain just below my left ribcage (in front) and kidney pain as well, although I believe that was from drinking too much water. I wonder how many others have felt that sharp pain?

Edits: Overall, I could have been more careful eating other stuff – but the IPA definitely felt like a trigger and may have been consumed “early”. I realize it’s an overall diet concept, per Keith’s advice. Also, I’m sorry I started this from a different profile accidentally. I couldn’t recall what I signed in with (thought it was just email and password) so chose amazon, which I now think was wrong….Keith, feel free to move this to my other profile or let me know what I did wrong. 🙂 Thanks!

[Mark]

About 2 years ago, my big toe was red, swollen and I was in a lot of pain. I finally went to the doctor and he simply said “you have gout”. I thought it was from a time I stubbed my toe. He then said, “does this hurt?” and squeezed it. It did not. So, he retracted and x-rayed it instead and said it was probably sprained. Thinking back now, maybe it was gout? It did not burn like everything I read describes. Now, about 2 months ago, I had a horrible fever and was in the hospital on IV for 4 days. Nothing showed up other than a 9mm kidney stone. I went to a urologist and he thinks it’s uric acid, because it was invisible on the x-ray, but visible on ultrasound. Since then, I have been very active, jogging, biking, canoeing, etc., with no issues. Suddenly, last week, I had all of my major joints swell (knees, elbows, wrists and ankles – nothing in the toes or feet) and the balls of my fingers (in the palms). I could barely get out of bed. Then, small masses (about the size of a bottle cap) started popping up in my legs. I went to the doctor and had blood work (they thought Lyme – but came up negative, as did the test from 2 months ago). Everything was “normal”. My uric acid was 6.8. After reading some things on this site, I see that being 6.8 vs 7.0 is not necessarily normal. From everything I am reading, putting the kidney stone and this joint flare up together, I am really thinking it is gout. The pictures of the lumps on the web and this site are hideous. Mine were barely visible and if I massaged them, I could make them almost go away. Also, when my joints flared up, massaging them felt good, whereas most of the things I read say gout patients are in pain just from the bed sheets touching them. My toes were perfectly fine, which I am reading is a misunderstanding now. I checked out clean for RA, Lupus, and everything else I see in my blood test.

I know I should ask my doctor more, but this site seemed very helpful and if it is gout, I will probably wind up bookmarking this site for tips on diet, etc.

Thanks

[Keith Taylor]

Of course it’s gout.

And, who wants uric acid to be normal?? (“Normal Uric Acid? No Thanks!” might be worth a search 😉 )

Normal means average. Average means a 6 in 100 chance that you have gout.

It’s much better to aim for safe, rather than average. Safe means a 0 in 100 chance that you stay with gout.

Your doc might be happy to give you a 6 in 100 chance of gout. I’m not. I will only be happy, Mark, when your uric acid is safe.

It’s nice of you to bookmark me. But, I’d much rather you post here every time you think of anything about gout.

Anything about gout. Or, anything.

[Dave Jones]

hi am 55 this year and get attacks in the feet and once in the hand

have tried to find the trigger agahhhh lol

i had and accdent on a motorcycle about 14 years back now lost splien and had a damaged kidney which they said poss come back sometime to sort it i have been to a doctor and they give me naproxain used to be diclophenic but stoped that for the first one so cant really say what starts it or poss a combination of all the things

thanks for a good site and more info than ive found before

[Posted via GoutPal Helpdesk ticket #2839 from Why do I have Gout?]

Gout is caused by years of high uric acid. It probably started in your 30s, but you never noticed it. … It does not trouble you at first. After a few years, it bites so hard you wonder if someone just ripped your toe off.

[Chand]

I am 70+.I am suffering from osteoarthritis.my foot and ankle r swollen.what to do?.Please guide me.thanks.

Swelling on the upper side of foot n ankle.it was on right foot before and now on left foot.I am feeling pain in my left kidney.

What should I eat and what not?would u please guide me?thanks my both knee r paining.I cannot walk.I can’t sleep.my left knee slips while standing.can I eat rice.

[Chand]

There is no swelling now on my ankle n foot.

[Keith Taylor]

Thanks for the update about your gout symptoms, Chand.

You need to be aware that gout pain and swelling will subside naturally in a few days. But, you must not ignore excess uric acid that causes gout. If you fail to control uric acid, gout will get worse. Eventually, it spreads to all joints. Gout prevents natural joint repair, so you will get damage to cartilage, tendons, and bone.

After that, gout spreads to soft tissues. You will get damaged skin, kidneys, and heart. All organs are at risk, except the brain.

I urge you to start treatment for uric acid control. If you want me to help you with this, please post your latest uric acid blood test results. Also post as much history as you can about symptoms, test results, and any gout treatments you have tried.

[bob earley]

Hi
I have an auto immune disease called microscopic polyangitis (mpa) which mainly effect the kidneys,for which I am taking 2 grams mycophenalate daily and aspirin for heart 75 mg daily,

I have had a few episodes of my left big toe and my left ankle seizing up which only lasts about 24/36 hours and then disappears.

I told my consultant who has done a urate test because he suspects gout, the result of which is in today at 743mmol/l.

can you tell me your opinions on this result .

I have no symptoms of gout at present

[Keith Taylor]

Hi Bob,

743 μmol/L is way too high. Because it’s over twice the upper limit of 350 for gout patients with kidney disease. But kidney problems make gout management too complicated for an online forum. So, you really must seek professional help today.

If you don’t know what to ask, we can help you formulate good questions for your medical team. Similarly, we can help you understand what your doctor tells you about gout. But we can’t give general help about gout with kidney disease. Except to say there are too many complex issues. So you need individual professional help

[Vincent Regan]

I am 75-year-old man stage III kidney disease I lost one kidney about 10 years ago don’t know where one too so I have one good working kidney or a month ago the Gout started it wasn’t too bad I didn’t even tell my doctor so about three days ago I woke up with terrible pain at 4 o’clock in the morning and when I try to stand up for more than five minutes my gouty back aches like hell i’m having a very hard time standing because my back was that aching so the doctor gave me two prescriptions one is a seven day thing and you take it continuously I could not go out shopping to the store could even make my own coffee this morning because the pot and things were in the dishwasher and I could not bend down to get them on my back would be acting so I’m wondering how long this is going to going to last Thank you for your help

[d q]

Hello Vincent,

Here at goutpal we try to help with all aspects of gout however I am not too sure I understand what is going on in your case?

You mentioned you had a gout attack a few days ago but you haven’t mentioned if you are taking any uric acid lowering treatment or not? You also haven’t provided us with any figures like your current uric acid levels?

What two prescriptions did your doctor give you? “A seven day thing” and no mention of the second medication doesn’t really help much in trying to understand and help your condition.

If you could provide us with a little further information maybe we can help you get better quicker 🙂

[Keith Taylor]

I’ve collected various threads here that relate to gout with kidney disease. Because, as I said earlier, this is usually too complicated for an online forum. So, generally, I want to refer kidney-related questions back to the doctor.

Anyway, here is a 12 point guide why this is complicated. Also, individual gout patients with kidney disease will have their own added personal complications. So, feel free to discuss general aspects of gout with kidney disease. But please discuss personal medical issues with your doctor.

I’ve changed the wording of this 12-point list to try to make it more readable. It’s from chapter 30 of Rheumatology and The Kidney (Courtney, Philip, and Michael Doherty. “Management of gout in the patient with renal disease.” Rheumatology and the Kidney (2012): 415.):

1. Gout is increasing in prevalence. In part due to the increasing frequency of end-stage kidney disease.
2. Kidney disease can cause uric acid to rise to the point where crystals form.
3. Other risk factors for gout include genetic predisposition, age, male gender, obesity, diet/lifestyle, and osteoarthritis.
4. Kidney disease often links with unusual gout and difficulties in management. Usual gout drugs might be toxic or otherwise inappropriate.
5. Education, information access, and lifestyle advice are important for gout patients with kidney disease.
6. For kidney disease patients, the single-joint gout attack is best managed by local ice-packs. Together with joint fluid draw and injection of intra-articular corticosteroid. Also, joint fluid analysis allows confirmation of the diagnosis.
7. Multi-joint gout attacks in kidney patients can be treated with a short course of systemic corticosteroids.
8. Lifestyle advice and treatment should reduce uric acid well below 6 mg/dl (360 µmol/l).
9. Allopurinol can be used at lower doses in patients with kidney disease. But the therapeutic target may not always be reached.
10. Febuxostat (Uloric) is a new alternative to consider for patients with kidney disease who cannot take allopurinol.
11. NSAIDs, colchicine, sulphinpyrazone, and probenecid are not suitable for patients with severe kidney disease. However, benzbromarone can be effective in patients with mild-moderate kidney disease.
12. Biological therapies that block IL-1β have been shown to be very effective in the treatment of acute attacks and may reduce the frequency of acute gout.

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