High uric acid links gout, kidney stones, and chronic kidney disease (CKD), with the right treatment, lifestyle changes, and regular monitoring, you can safeguard your kidneys for the long term.
Living with gout means thinking beyond painful flares and swollen joints, as the disease carries multiple comorbidities. Maintaining strong kidney health is a critical part of managing gout over the long term, because the same uric acid that causes flares damage your kidneys over time.
How are gout and kidney disease connected?
Gout is a form of inflammatory arthritis caused by a buildup of uric acid crystals in the joints, which can lead to permanent joint damage if left untreated.
Uric acid is a normal waste product that usually dissolves in the blood and is filtered out through the kidneys into the urine or through the bowels.
When there is more uric acid than the body can remove, high uric acid in the blood, or hyperuricemia, develops and crystals can form in joints and other tissues, triggering painful gout flares.
The relationship between gout and kidney disease goes both ways. People with gout are more likely to develop kidney disease, and people with kidney disease are more likely to have gout, since their kidneys cannot clear uric acid as effectively. Over time, high uric acid and uncontrolled gout can contribute to decreased kidney function and health outcomes.
How are kidney stones and chronic kidney disease connected to gout?
About 1 in 5 people with gout will develop kidney stones, which makes prevention and early treatment especially important. These stones form when uric acid crystals deposit in the kidneys and can be extremely painful. If kidney stones are not treated, they can block the urinary tract, leading to infections, permanent scarring, and damage to kidney tissue.
That damage can progress to chronic kidney disease (CKD). In severe cases, untreated kidney disease can lead to kidney failure, or loss of kidney function. In fact, kidney disease and gout are closely linked to one another. CKD is a major contributor of gout because impaired kidney function leads to uric acid buildup. Conversely, high uric acid may contribute to CKD progression, creating a vicious cycle.
What lifestyle changes help with gout and kidney health?
Several daily habits can support kidney health when you live with gout:
- Take prescribed gout and uric acid–lowering medications exactly as directed, and do not stop them without talking to your doctor, even if you feel better.
- Drink at least eight cups of water a day to help flush the kidneys and remove uric acid from your bloodstream.
- Avoid excessive intake of purine-rich foods that may trigger gout flares such as red meat, shellfish, and alcohol. Also, limit items made with high-fructose corn syrup, like many soft drinks and processed foods.
- Exercise regularly, maintain a healthy body weight, and avoid smoking to support overall kidney and cardiovascular health.
- Work with your doctor to control other conditions like obesity, high blood pressure, high cholesterol, and diabetes, which can raise uric acid and harm the kidneys.
- Share a complete list of medications and supplements with your doctor, since some can increase uric acid levels.
What does gout treatment look like with kidney disease?
Gout treatment looks a bit different in those with kidney disease. Non-steroidal anti-inflammatory drugs (NSAIDs) may not be an option for pain relief due to their harmful impact on the kidneys. Instead, your doctor is most likely to prescribe and/or recommend colchicine or low-dose steroids (prednisone) if you can’t take NSAIDs.
Common uric acid lowering medications like allopurinol and febuxostat should be started at a low dose, especially if you have kidney disease. These medications can gradually be increased until your serum uric acid level reaches less than 6.0 mg/dL. As outlined on our podcast, historical dosing restrictions for allopurinol in chronic kidney disease have led to undertreatment, but recent evidence supports gradual titration to higher doses when monitored.
Medications like probenecid that promote elimination of uric acid through the kidneys are not as effective in gout patients with lower kidney function but can be used in conjunction with other uric acid lowering drugs.
What are key health benchmarks for gout and kidney health?
To lower the risk of gout flares, kidney stones, and kidney damage, it’s recommended to maintain a healthy serum uric acid level of less than 6.0 mg/dL. You should get your uric acid level checked every six months if you have gout.
Regular blood tests are also important to monitor kidney function, including measures such as glomerular filtration rate (GFR), which measures how well your kidneys filter blood. A GFR below 60 may indicate kidney disease; a GFR below 15 indicates kidney failure. Understanding your uric acid level and kidney function puts you in a stronger position to protect your kidneys.
By monitoring your uric acid and making kidney-kind choices every day, you can reduce gout flares and help protect your kidney health for the long term. Learn more about maintaining kidney health with gout in our Gout and Kidney Health Brochure.
