AANP Family Nurse Practitioner (FNP) Certification ExamPlanEasy
A 68-year-old male with a history of chronic kidney disease (CKD) stage 3 presents with new-onset gout. He reports severe pain and swelling in his right great toe. Which of the following pharmacological treatments is most appropriate for acute gout in this patient?
- AHigh-dose oral colchicine
- BPrednisone
- CNaproxen
- DIndomethacin
Show answer & explanationAnswer & explanation
Correct answer: B. Prednisone
In patients with chronic kidney disease, NSAIDs and colchicine are often contraindicated or require significant dose adjustments due to their renal excretion and potential for toxicity. Prednisone is a safe and effective option for acute gout flares in this population.
Why the other options are wrong
- A. High-dose colchicine is associated with significant gastrointestinal and myelosuppressive side effects, especially in patients with CKD, and is generally avoided for acute flares.
- C. Naproxen, an NSAID, is contraindicated in patients with CKD due to the risk of worsening renal function.
- D. Indomethacin, an NSAID, is contraindicated in patients with CKD due to the risk of worsening renal function.
Acute Gout in CKD
Management of acute gout flares in patients with chronic kidney disease requires careful selection of medications to avoid exacerbating renal dysfunction.
- NSAIDs are generally contraindicated in CKD due to nephrotoxicity.
- Colchicine requires significant dose reduction or avoidance in moderate to severe CKD.
- Systemic corticosteroids (e.g., prednisone) are preferred for acute flares in CKD patients.
Memory trick: Kidney-Friendly Gout Relief: Steroids are the Safe Bet!