My 73 year old dad has had gout for 50 years, now eGFR is 34 and uric acid is 9.6
My dad is 73 and has had gout for almost 50 years. He started having gout in his 20s. Unfortunately, where he lived before, medical care was pretty limited and his gout was never really treated properly. Basically whenever he had pain, he would take some kind of anti-inflammatory/pain medication. He never had consistent long-term treatment to actually lower his uric acid.
After having gout for this long, he has a lot of tophi, and many of the joints in his hands and feet have already been damaged by gout.
He recently came to the US and we are finally trying to get this properly treated.
His recent blood work here showed:
Uric acid 9.6
Creatinine 2.05
eGFR 34
BUN 45
Potassium 4.4
Hemoglobin 10.3
He had blood work done in his home country about two weeks before this. At that time his creatinine was 155.6 umol/L (around 1.76 mg/dL) and uric acid was 498.2 umol/L (around 8.4 mg/dL).
He also had an ultrasound there. His left kidney is quite small, about 7.2 cm, and the report says the kidney tissue is thin (around 0.7 cm). They also saw some small possible stones/calcifications in both kidneys. No hydronephrosis. His prostate is enlarged as well.
The concerning part is that for years he has been taking different medications from his home country whenever his gout bothered him, and sometimes he would take an “anti-inflammatory” medication every day so he wouldn’t have pain. We don’t even know exactly what was in some of those medications. His US doctor told him to stop taking anything when we don’t know exactly what it is, especially with his kidney function.
Right now he actually has no gout pain.
His doctor just started him on 50 mg allopurinol once a day. I know that’s a very low dose, but I’m assuming it’s because his kidney function isn’t great and they want to start slowly.
I’m curious if anyone here has been in a similar situation, especially someone older with CKD and a very long history of gout.
Now that his kidney function is not great, it seems like his options for uric acid lowering medications are more limited. I feel like there’s no really good solution.
Ps: I have scheduled an appointment for him to see the specialist but that’s a long waiting and that’s why I am asking advice here.
Thank you!