Tag Archives: gout flare

Colchicine in Renal Failure

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Colchicine is a wonder drug for a gout flare. Two consecutive dose is enough to abate the inflamed joint. Hospitalized patients who have history of gout are susceptible to gout flare due to physical trauma, surgery, immunosuppressant drugs Ciclosporin and Tacrolimus, use of diuretics and metabolic syndrome. Since Colchicine is excreted 10- 20 % unchanged in the kidneys it is highly probable to cause toxic accumulation in a renal failure patient. Colchicine can not be removed through dialysis nor does it have an antidote to combat any toxic effect. For this reason prescription of this medication for an acute gout flare should be limited to 2 doses then prophylactic as needed treatment. A few of its distinctive side effects include gastrointestinal upset( diarrhea, vomiting)and symptoms of peripheral neuropathy ( tingling, burning, restless upper and lower extremities) secondary to damage of the peripheral nerves from colchicine toxicity.

What Happens during Gout Flare?
Hyperuricemia is the main cause of gout. Due to an increased uric acid in the blood and slow excretion, uric acids favorite stop are the joints causing uric acid crystal formation, because it is a foreign and an abnormal process the body protects itself from invasion by sending guards to destroy and get rid of this deposits. As plasma and leukocytes which are mainly neutrophils floods the area, an acute inflammation occurs. The area becomes red and hot due to increased blood flow, swelling occurs due to fluid build up and becomes very painful and tender because of damaged nerve endings.

How does Cochicine work?
With Colchicine, it inhibits the activity of neutrophil flooding the area, with decrease in neutrophils, inflammation slows down and pain is lessened.

How to control Gout?
Once the flare is under control, Alluporinol should be taken to block uric acid formation. Uric acid is a by product of purine metabolism, a diet high in purine should be avoided ( e.g. herring, tuna, anchovies, scallops, beer,red meat, turkey.. pls. see reference).

Case study and analysis:
My patient encounter had opened my eyes to investigate Colchicine. Patient have a history of gout and takes allupurinol daily and colchicine as needed for gout flare. In this hospitalization, many things had happened although he has chronic kidney disease hemodialysis is now his last resort of cleansing the body from toxins and waste products of metabolism as well as correcting electrolyte imbalance and fluid excess. He started to have joint pains and was attributed to gout flare. Colchicine BID was started. My second night of encounter patient was restless and was unable to sleep. Trazodone barely helped as he only started to sleep at around 4 am. The following night he complained of the same but now with jumpy burning feet which is new for him. Tracking down what could have caused this symptom pointed to Colchicine. With him who have kidney failure, colchicine toxic accumulation is inevitable. He had already taken said drug for the past 3 consecutive days. My PA that night was very helpful. Patient rested well after 1 mg of IV Ativan. Colchicine was decreased to PRN only. Because it is a weekend his next dialysis is Monday. Even then, colchicine cannot be removed through dialysis. Will he continue to have this symptom of peripheral neuropathy? Highly probable for sometime. This is my last night with him and I will be off for 3 days. But at least the culprit was found.

Reference:
1. Health;Foods to avoid if you have gout
By Anne Harding
2.Colchicine
From Wikipedia, the free encyclopedia
“In August 2009, colchicine won Food and Drug Administration (FDA) approval in the United States as a stand-alone drug for the treatment of acute flares of gout and familial Mediterranean fever.[12][13] It had previously been approved as an ingredient in an FDA-approved combination product for gout. The approval was based on a study in which two doses an hour apart were effective at combating the condition.”
3.Gout
From Wikipedia, the free encyclopedia
4.Allopurinol
From Wikipedia, the free encyclopedia
5.Hyperuricemia
From Wikipedia, the free encyclopedia

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