Does gouty nephropathy exist, and is it more common than we think?

Gout is present in one third of subjects with CKD but is usually an exclusion criterion in clinical trials investigating the role of uric acid in kidney disease. Bardin et al. report that one third of gouty subjects have hyperechoic medullas by ultrasound (consistent with crystalline deposits) that correlates with increased risk for hypertension and kidney dysfunction and which were not observed in >500 controls. If validated, a “gouty nephropathy” from microcrystalline deposits could be an important, unrecognized cause of CKD.