Chronic urate nephropathy in the past decades was a frequent cause of renal failure in gouty patients but this entity has become very rare in the recent years and in many centers of hemodialysis the registries of chronic renal failure populations do not list gouty nephropathy as a cause.
Some authors even discuss the existence of gouty nephropathy (1). In our series of 140 patients with primary gout (128 M, 12 F) including 20 patinets with late onset (over 65 years) of the disease (15 M, 5 F) we never observed renal insufficiency with serum creatinine over 1.5 mg/dl; but the urate nephropathy exist also as a rare familial form, inherited in a autosomal dominant manner and, more rarely, as an idiopathic form, without clinical evidence of gouty arthritis.
Recently we observed an idiopathic form of this disease in a male patient, 51 years old, who presented a middle renal insufficiency (serum creatinine over 2.0 mg/dl and albuminuria).
Ultrasonic kidney study and C.A.T. have shown numerous microcysts in the cortical of the kidney, but only the needle biopsy has confirmed the urate nature of the interstitial chronic nephropathy.
1- L.H. Beck Kidney Int. 30 (1986) 280-286.