Disappearance of a Gouty Nodule after Hemodialysis Initiation

A 51-year-old Japanese male received hemodialysis to chronic kidney disease (CKD) due to nephrosclerosis and gout. When he was 47-year-old, he was visited to our hospital for gouty attack. Laboratory tests showed serum creatinine level to be 3-4 mg/dl while serum uric acid level fluctuated (9-15 mg/dl). A prominent gouty nodule of the thumb joint appeared ( Figure 1). In addition, uric acid crystals were found in his synovial fluid. Therefore, we started him on a treatment regimen of losartan, febuxostat, allopurinol, and benzbromarone. However, he still had frequently recurring gout attacks. His condition gradually progressed to CKD and hemodialysis was eventually started approximately 3 years ago. After hemodialysis initiation, his pre-dialysis serum uric acid level was slightly elevated (7-8 mg/dl). Subsequently, his gout attacks stopped. Furthermore, surprisingly, his gouty nodule disappeared 1 year after hemodialysis initiation (Figure 2). We suggest that gouty nodule is treatable.

Keywords: Gouty Nodule; Hemodialysis