A New Study Shows The Link Between Hyperuricemia, Gout, & Kidney Disease -

When the city of Flint, Michigan changed its water source from treated Detroit Water and Sewerage Department water to water from the Flint River, the Flint River water caused lead from aging pipes to leach into the city’s water supply, elevating the levels of lead in the drinking water and creating a severe public health crisis. The news about lead exposure in Flint’s drinking water has renewed the recurrent concerns of public health officials about the environmental causes of kidney disease.

For years, health officials in the United States have worked to eliminate the public’s exposure to lead by reducing the amount of lead in our everyday environment. We’ve stopped producing lead-based gasoline and paint, we’ve removed the lead paint from older schools and homes, while public health officials have closely monitored the public’s levels of lead exposure. These efforts have significantly reduced the number of cases of lead-linked kidney disease.

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Lead toxicity is usually detected in two groups: children and persons prone to chronic kidney disease (CKD). In children, lead exposure usually happens through ingesting leaded paint chips or inhaling leaded paint or gasoline. Exposure can lead to neurologic toxicity – especially in children – associated with anemia and with intellectual deficits that are only observable years later. Lead exposure is rare in the U.S. today thanks to the reduction of lead paint and leaded gasoline. If you have CKD, and if you think that you may have been exposed to lead, it is imperative to seek the proper treatment from someone who is familiar with chronic lead toxicity.

HOW DOES LEAD COMPLICATE KIDNEY DISEASE?

Low-level, long-term exposure to lead in cases of CKD can be difficult to detect. Diabetes and hypertension patients who are prone to develop chronic kidney disease are more likely to accumulate lead in the body because of the body’s inability to eliminate lead through the kidneys. Lead-linked kidney disease, known as interstitial nephritis, progresses more rapidly than other kidney diseases because of the body’s inability to eliminate lead. Patients with lead-associated kidney disease may also suffer from gout, high blood pressure, and chronic anemia in addition to the accelerated progress of their kidney disease.

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Miami medical malpractice attorney Jed Kurzban focuses his legal practice on representing CKD patients who are the victims of medical malpractice. He says, “Unfortunately, kidney disease is insidious. It often presents in ways that are unexpected, such as tea colored urine, high blood pressure or gout. If any of these symptoms, or laboratory signs such as high protein or blood in the urine or high creatinine in the blood occur, seek immediate medical intervention. Time is almost always of the essence in kidney disease.”

Treatment goals for lead-linked kidney disease must include eliminating the lead exposure and effectively treating the diabetes, high blood pressure, and/or gout that may complicate the underlying kidney disease. Chelation therapy generally is not pursued because studies have shown that chelation therapy is not necessarily effective for reducing the lead levels in kidney disease patients.

WHAT IS GOUT AND HOW IS IT LINKED TO KIDNEY DISEASE?

Gout is a painful form of inflammatory arthritis that occurs when hyperuricemic crystals are deposited in the joints and tissues. Almost 40 percent of the patients diagnosed with gout in the United States also suffer from chronic kidney disease. Incidences of gout in kidney patients increase as kidney function declines over time. The increasing number of patients suffering from the combination of gout and kidney disease has led to a growing interest among medical researchers in the link between hyperuricemia (an abnormally high level of uric acid in the blood) and kidney disease.

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For example, The Open Urology & Nephrology Journal recently devoted an entire edition to research regarding the links between lead exposure, uric acid, hyperuricemia, gout, diabetes, high blood pressure, and kidney disease. Researchers have concluded that the link between hyperuricemia and kidney disease appears to be the chronic, low-grade, systemic inflammation that is intrinsic to both conditions. The kidneys excrete uric acid, predisposing CKD patients to hyperuricemia. Unfortunately, these patients have contraindications to a number of agents used in the management of gout.

For example, medicines that raise serum uric acid levels, such as thiazide and loop diuretics, are often recommended treatments for CKD, but guidelines recently issued by the American College of Rheumatology (ACR) say that chronic kidney disease is an indication for urate-lowering therapy in patients with a history of hyperuricemia or gout. Every patient’s condition and medical history must be considered individually and in detail.

WHAT IS THE RISK OF MALPRACTICE FOR KIDNEY DISEASE PATIENTS?

Inevitably, with almost four million patient visits for gout in the United States each year, and with more than twenty million kidney disease patients, mistakes are going to be made. A kidney disease patient who receives the wrong prescription or treatment may be a victim of medical malpractice. Patients additionally suffering from gout, diabetes, or hyperuricemia as well as CKD are particularly at risk for malpractice related to misdiagnosis or to malpractice related to improper prescription medications. Any kidney disease patient who believes he or she has been a target of medical malpractice should discuss the situation with a medical malpractice attorney.

Anyone can develop kidney disease, and it is a growing problem in the United States. When someone struggles with kidney disease, medical malpractice can be catastrophic. Kidney disease does not go away, but if detected early, most patients can manage it adequately with the proper medications. Misdiagnosis, the failure to diagnose, or inappropriate treatment of kidney disease may constitute medical malpractice and lead to a quick decline in a patient’s condition.

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A number of treatment options are available to kidney disease patients. The appropriate treatment depends on a variety of factors: the precise type of kidney disease, how early the disease is detected, and the patient’s age and medical history. Steroids are effective for some kidney diseases, and prescription pharmaceuticals are recommended for some types of kidney disease.

HOW DOES THE LAW DEFINE MEDICAL MALPRACTICE?

The law precisely defines medical malpractice as the violation of the “reasonable standard of care” provided by most doctors. Unless you are a doctor yourself, it’s genuinely difficult for a kidney disease patient to know if he or she is a malpractice victim. Every malpractice case is unique, and every charge of malpractice must be examined from both the legal and medical perspectives.

The water crisis in Flint, Michigan is continuing. Most residents are now using water filters, but bottled water is still advised by health authorities for at-risk residents, including pregnant women and small children. The crisis will eventually end, but the ultimate consequences of lead in the city’s water, including kidney diseases and intellectual deficits in young children, won’t be seen or known for years to come.

By: Jed Kurzban

Medical malpractice attorney Jed Kurzban graduated from the University of Alabama in 1992 and earned his Juris Doctor from the University of Miami School of Law in 1995. He is a member of the Dade County Bar Association, the Florida Bar Association, the American Association for Justice, the Academy of Florida Trial Lawyers, and the American Bar Association. Mr. Kurzban is happily married and the father of two.