A female gouty patient with recurrence of gout flare considered to be due to abuse of diuretics and gouty kidney findings on ultrasonography

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  • 利尿薬の乱用が原因と考えられる痛風発作を繰り返し，超音波検査上痛風腎の所見を呈した女性痛風の一例

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Abstract

<p>A 50-year-old woman who had been abusing of furosemide and torasemide for 8 years because of edema during menstruation, had hyperuricemia (11-13 mg / dL), and showed repeated episodes of gout flare. Abdominal ultrasonography revealed gouty kidney-like findings (hyperechoic medulla). Of the 5208 abdominal ultrasonographies performed for patients with gout or hyperuricemia during the five years from 2017 to 2021, only 22 cases showed hyperechoic medulla findings; therefore, hyperechoic medulla findings are considered to be rare. We reviewed the findings of abdominal ultrasonography performed multiple times for 11 patients who had been treated with uric acid-lowering drugs for 5 years or more. As a result, no improvement in hyperechoic medulla findings was observed. These results contradicted a report from Vietnam stating that hyperechoic medulla findings were improved in 36% of 502 patients with severe gout by uric acid-lowering treatment. Therefore, we consider that it is necessary to clarify whether hyperechoic medulla findings in patients with gout and hyperuricemia are due to reversible urate crystal deposition or irreversible renal medulla substrate changes.</p>

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