What is gout?

Gout is a form of arthritis caused by crystals that form in the joins from too much uric acid in your blood. Kidney disease can increase your risk for gout, and having gout may affect your kidneys. Flares, or sudden gout attacks, can come on quickly and be very painful.

There are two types of gout, and knowing the difference can help you manage your symptoms. 

• Acute gout: Acute gout attacks cause sudden, intense joint pain, swelling, and redness that lasts from a few days up to a week and usually only affects one joint. You will only feel symptoms during the attack, not before or after. 
• Chronic gout: Chronic gout is when you have 2 or more gout attacks a year. Multiple joints are usually affected. While there may be short periods between attacks, you can feel symptoms anytime. Chronic gout can lead to permanent joint stiffness, damage, and deformities. 

Both acute and chronic gout may lead to kidney disease. If you have gout, talk to your doctor about preventing kidney disease. 

How are gout and kidney disease related?

Gout is caused by having too much uric acid in your blood. When uric acid builds up in the fluid around your joints, it can form tiny crystals called urate crystals. Urate crystals can cause pain and swelling in these joints. These attacks often happen in the big toe but can also affect joints like your elbows, knees, hands, or ankles. 

If you have kidney disease, your body may have trouble removing uric acid. This leads to uric acid buildup and crystals, which can cause gout. Gout may also damage the kidneys over time if left untreated.

What are the symptoms of gout?

Gout attacks, also called flares or flare ups, come on suddenly and can become extremely painful. 

These attacks can last from a few hours to several days and are more likely to happen in the morning or at night. You may even have a gout attack while you are sleeping.  Gout symptoms can vary depending on the type of gout you have, but it often begins with pain in one joint, usually the big toe. 

Early signs of a gout flare may include:

• Tingling, stiffness, or slight discomfort in a joint
• Redness or warmth in the area
• Swelling that comes on gradually

Symptoms of a gout flare often include:

• Sudden, intense joint pain — often starting at night or early morning
• Swelling, redness, and warmth around the joint
• Tenderness that makes it painful to move or touch the joint
• Skin that may appear shiny or stretched over the joint

Gout flares also commonly affect the knees, ankles, elbows, wrists, and fingers.

These attacks can last from a few hours to several days and may go away on their own, but gout can become more frequent and severe if left untreated.

How can I manage gout attacks?

While there is no cure for gout, there are things you can do to reduce swelling and manage pain. 

To manage gout pain and swelling during an attack:

• Take medicines, including nonsteroidal anti-inflammatory drugs (NSAIDS), colchine, and steroids to reduce swelling and pain. Be sure to talk to your doctor. Some medicines like aspirin and ibuprofen  are not suggested when you have kidney disease.
• Stay hydrated. If you have fluid restrictions because of kidney disease, talk to your doctor.
• Avoid alcohol and food high in purines.
• Keep pressure off the affected joint. Try walking with a cane if your toes or feet are affected.
• Elevate your affected joint.
• Use an icepack to keep your joint cool.
• Find ways to manage stress from the pain, like deep breathing and meditation.

Who is at risk for gout?

Gout can affect anyone, even people who don't have a family history of gout. Some groups are more likely to develop gout due to a combination of biological and lifestyle factors. Biological risk factors are physical or genetic traits that can make you more likely to develop a disease.

Demographics at higher risk include:

• Adult men (most common)
• Women after menopause
• People who are Black or Asian Pacific Islander

Other risk factors include:

• Being overweight
• Drinking alcohol
• A family history of gout 
• Eating foods high in purines 

Understanding risk factors is the first step to protecting your kidney health. Learn how other conditions like high blood pressure and diabetes can increase your chances of developing kidney disease. Learn more.

Certain medicines can increase uric acid or damage kidneys, including:

• Diuretics (water pills)
• Beta blockers, medicines that work to slow down heart rate and reduce blood pressure
• Vitamin B3 supplements 
• Anti-rejection medicines (cyclosporine)
• Levodopa (a medicine used to treat Parkinson's disease) 
• NSAIDs like aspirin and other medicines that contain salicylate

NSAIDs, some of the most common pain-relieving medicines for gout, can also lead to kidney disease over time. Talk to your doctor about how to manage your use of NSAIDs.

Having certain health conditions can also increase your risk of gout, including:

• Chronic kidney disease
• High blood pressure
• Diabetes
• Heart Disease
• Hypothyroidism
• Psoriasis
• Hemolytic anemia
• Some cancers
• Some genetic disorders 

What are the tests for gout?

If you think you might have gout, it's important to get diagnosed by a doctor so that you can get the treatment you need. The tests can include:

Synovial fluid test
The synovial fluid test is the most accurate test for gout. Synovial fluid is a liquid found in your joints. This test examines the fluid for urate crystals that indicate that you have gout.

A synovial fluid test only takes a few minutes. You may first be given anesthesia, a medicine to numb the area, through a shot using a small needle. 

Uric acid test
Doctors use blood and urine tests to check uric acid levels, which can help diagnose gout. Normal levels are 3.5–7.2 mg/dL in blood and 250–750 mg in urine (collected over 24 hours).

Neither the uric acid blood nor the urine test should be used alone when diagnosing gout. Doctors use the results together with other tests to confirm.

Imaging tests
To confirm that your joint pain isn't due to injury, your doctor may use imaging tests, like an X-ray or ultrasound, to diagnose gout. 

Can I prevent gout?

Gout is usually treated with medicine, but there are some lifestyle changes you can make to help prevent and decrease the number of gout attacks you experience. 

There is evidence that vitamin C can lower uric acid levels and help manage gout. Foods high in vitamin C include cherries, oranges, bell peppers, and broccoli.  It's also important to stay hydrated if you have gout because water can prevent uric acid from building up. Aim to drink at least eight 8-ounce glasses of water a day. 

Foods high in vitamin C include:

• Kiwi
• Strawberries
• Oranges
• Papaya
• Pineapple
• Mango
• Broccoli
• Brussels sprouts
• Red bell peppers
• Green bell peppers
• Kale

Purines are chemicals in your body and food that can create uric acid. Avoiding foods high in purines can help manage gout. 

Foods high in purines include:

• Alcohol, especially beer 
• Red meat like beef, lamb, and pork
• Animal organs (brains, kidneys, liver, sweetbreads, etc.) 
• Some kinds of seafood (shellfish, anchovies, mussels, trout) 
• Foods with high-fructose corn syrup (sodas, canned soups, baked goods, salad dressings) 
• Most seafood, like anchovies, shellfish, sardines, and codfish.

Learn more about eating a kidney-friendly diet.