Chronic Tophaceous Gout Complicated By Metabolic Disorders and Stage IV Chronic Kidney Disease: A Clinical Case Report

Abstract

Gout is one of the most prevalent inflammatory arthritides and is frequently associated with chronic kidney disease (CKD), metabolic syndrome, and cardiovascular comorbidities. Long-standing hyperuricemia and poor adherence to urate-lowering therapy contribute to the development of severe disease manifestations, including tophi formation, urate nephropathy, and progressive renal dysfunction. We present a clinical case of a 62-year-old man with a 20-year history of gout complicated by extensive tophaceous deposits, stage G4 chronic kidney disease, urate nephrolithiasis, metabolic syndrome, dyslipidemia, and hepatic steatosis. Clinical examination revealed multiple tophi involving the auricles, hands, feet, Achilles tendons, and large joints, accompanied by joint deformities and functional impairment. Laboratory findings demonstrated persistent hyperuricemia, inflammatory activity, anemia, impaired renal function, and metabolic abnormalities. Imaging studies confirmed characteristic erosive joint lesions, osteoporosis, nephrolithiasis, and fatty liver disease. A comprehensive treatment strategy including febuxostat, low-dose colchicine, renin-angiotensin system blockade, ketoanalogue supplementation, lipid-lowering therapy, and lifestyle modification was implemented. The case highlights the clinical consequences of inadequate long-term control of hyperuricemia and emphasizes the importance of early diagnosis, strict adherence to urate-lowering therapy, and multidisciplinary management involving both rheumatologists and nephrologists.