The Renal Lesion in Gout
Authors: HARVEY C. GONICK
Journal: Annals of Internal Medicine (1965)

Article1 April 1965The Renal Lesion in GoutHARVEY C. GONICK, M.D., MILTON E. RUBINI, M.D., IRENE O. GLEASON, M.D., SHELDON C. SOMMERS, M.D.HARVEY C. GONICK, M.D.Search for more papers by this author, MILTON E. RUBINI, M.D.Search for more papers by this author, IRENE O. GLEASON, M.D.Search for more papers by this author, SHELDON C. SOMMERS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-62-4-667 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptProgressive renal failure is a frequent cause of death in gout, the incidence varying from 22 to 25% in reported series (1, 2). Traditionally, the kidney lesion has been described as consisting of a combination of pyelonephritis, advanced arterio-nephrosclerosis, and tophus formation (2-6). Only the last finding, however, is thought to be diagnostic (1). It has been suggested from studies of autopsy material that the renal lesions stem from deposition of urates in collecting tubules, with resultant obstruction, atrophy of the more proximal tubules, and secondary necrosis and fibrosis (3-6). The associated interstitial inflammatory process has been attributed to a...References1. MAYNE JG: Pathological study of the renal lesions found in 27 patients with gout (abstract). Ann. Rheum. Dis. 15: 61, 1956. Google Scholar2. TALBOTTTERPLAN JHKL: The kidney in gout. Medicine 39: 405, 1960. CrossrefMedlineGoogle Scholar3. FAHR T: Handbuch der Speziellen Pathologischen Anatomie and Histologie. Vol. I, by HEAKE, F., LUBARSCH, O., Springer Verlag, Berlin, 1926. (Quoted by Talbott (2)). Google Scholar4. BROWNMALLORY JGK: Renal changes in gout. New Eng. J. Med. 243: 325, 1950. CrossrefMedlineGoogle Scholar5. BELL ET: Renal Diseases, 2nd ed. Lea & Febiger, Philadelphia, 1950, p. 413. Google Scholar6. MODERNMEISTER FWL: The kidney of gout, a clinical entity. Med. Clin. N. Amer. 36: 941, 1952. CrossrefGoogle Scholar7. FINEBERGALTSCHUL SKA: The nephropathy of gout. Ann. Intern. Med. 44: 1182, 1956. LinkGoogle Scholar8. SPITZSTEINBROCKERSCHWARTZSCHITTONE HOSM: Fulminating fatal gout. Amer. J. Med. 6: 513, 1949. CrossrefMedlineGoogle Scholar9. GREENBAUMROSSSTEINBERG DJHVL: Renal biopsy in gout. Brit. Med. J. 1: 1502, 1961. CrossrefMedlineGoogle Scholar10. SOMMERSRELMANSMITHWICK SCASRH: Histologic studies of kidney biopsy specimens from patients with hypertension. Amer. J. Path. 34: 685, 1958. MedlineGoogle Scholar11. KIMMELSTIELPORTER PWB: Medical progress; intercapillary glomerulosclerosis. New Eng. J. Med. 238: 876, 908, 1948. CrossrefMedlineGoogle Scholar12. GELLMANPIRANISOOTHILLMUEHRCHEKARK DDCLJFRCRM: Diabetic nephropathy: a clinical and pathologic study based on renal biopsies. Medicine 38: 321, 1959. CrossrefMedlineGoogle Scholar13. BLOODWORTHSOMMERS JMSC: "Cirrhotic glomerulosclerosis," a renal lesion associated with hepatic cirrhosis. Lab. Invest. 8: 962, 1959. MedlineGoogle Scholar14. BARKAANDERSON TPJ: Histochemistry: Theory, Practice and Bibliography. Hoeber Medical Division, Harper & Row, New York, 1963. Google Scholar15. EPSTEIN FH: Nephropathy of hypercalcemia, in Diseases of the Kidney, edited by STRAUSS, M. B., WELT, L. G., Little, Brown and Co., Boston, 1963, pp. 652-674. Google Scholar16. HEITZMANCAMPBELLSTEFANINI EJJSM: Paroxysmal nocturnal hemoglobinuria with hemosiderin nephrosis. Amer. J. Clin. Path. 23: 975, 1953. CrossrefMedlineGoogle Scholar17. KINCAID-SMITH P: Vascular obstruction in chronic pyelonephritic kidneys and its relation to hypertension. Lancet 2: 1263, 1955. CrossrefGoogle Scholar18. HEPTINSTALLMICHAELSBRUMFITT RHLW: The evolution of the experimentally produced pyelonephritic lesion, in Biology of Pyelonephritis (Henry Ford Hospital International Symposium), edited by QUINN, E. L., Kass, E. H., Little, Brown and Co., Boston, 1960, pp. 249-257. Google Scholar19. BRUNRAASCHOU CF: Recognition of pyelonephritis in percutaneous renal biopsies, Ibid., pp. 225-239. Google Scholar20. JACKSONPOIRIERGRIEBLE GGKPHG: Concepts of pyelonephritis: experience with renal biopsies and long-term clinical observations. Ann. Intern. Med. 47: 1165, 1957. LinkGoogle Scholar21. HUTTCHALMERSMACDONALDDEWARDENER MSJAJSHE: Pyelonephritis; observations on the relations between various diagnostic procedures. Lancet 1: 351, 1961. CrossrefMedlineGoogle Scholar22. BROD J: Chronic pyelonephritis. Lancet 1: 973, 1956. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Los Angeles, California and New York, New YorkFrom the Departments of Medicine, Wadsworth Veterans Administration Hospital, and the University of California at Los Angeles Center for Health Sciences, and the Department of Pathology, Columbia University College of Physicians and Surgeons, Francis Delafield Hospital Division, New York, N.Y.This work was supported by grants from the Southern California Arthritis and Rheumatism Foundation, the Los Angeles County Heart Association, Merck Sharpe & Dohme and Geigy Pharmaceuticals.This paper was presented in part at the combined Regional Meeting of the American College of Physicians at Las Vegas, Nev., on February 6-9, 1964.Requests for reprints should be addressed to Harvey C. Gonick, M.D., Metabolic Unit, Wadsworth Veterans Administration Hospital, Los Angeles, Calif. 90073. 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KLINENBERG, M.D., F.A.C.P., RODNEY BLUESTONE, M.B., M.R.C.P., LEE SCHLOSSTEIN, M.D., JERRY WAISMAN, M.D., MICHAEL W. WHITEHOUSE, D. Phil.Hyperuricemia in Health and DiseaseTertiary hyperparathyroidism—Does it exist?An unusual form of renal disease associated with gout and hypertensionStructural-functional correlations in renal diseaseClinical survey of 354 patients with gout.Hypoxanthine-Guanine Phosphoribosyltransferase Deficiency in GoutWILLIAM N. KELLEY, M.D., MARTIN L. GREENE, M.D., FREDERICK M. ROSENBLOOM, M.D., J. FRANK HENDERSON, PH.D., J. E. SEEGMILLER, M.D.Allopurinol in the treatment of uraemic patients with gout.Recent Advances in the Rheumatic DiseasesEPHRAIM P. ENGLEMAN, M.D., F.A.C.P., MARTIN A. SHEARN, M.D., F.A.C.P.Hyperuricemia in Primary and Renal HypertensionUric Acid, Gout, and the KidneyTHE KIDNEY IN HEPATIC DISEASE AND IN GOUT: CLINICAL AND PATHOLOGIC ASPECTSGout 1 April 1965Volume 62, Issue 4Page: 667-674KeywordsGoutHospital medicineInflammationLesionsPathogenesisPyelonephritisRenal failureSurgeonsUric acidVeteran care Issue Published: 1 April 1965 PDF downloadLoading ...