October 29, 2011 at 7:56 am #3673
Hi there, I'm new to the forum and a long term kidney patient – stage 5, and close to needing RRT. I get gout attacks about twice a year, and this last flareup has been particularly nasty. Kidney patients are not allowed to take any anti-inflammatory drugs – so it hasn't been pleasant.
I have some diet questions – as it appears that many “gout-friendly” foods are bad for the kidneys, and vice-versa.
As a renal patient I am on a low potassium/low phosphate diet which means restricting my intake of most fruits and vegetables (particularly bananas) also I am supposed to avoid dairy products, pulses and nuts.
I've always been vegetarian, but since I've been on the renal diet I've been eating a little fish – I need to get my protein from somewhere, and I was at risk of becoming totally eggbound. I don't touch shellfish – it's high phosphate (except mussels).
I'm supposed to eat white bread/rice/pasta as opposed to brown, and I take soya milk in my tea.
I see a renal dietician fairly regularly as part of my treatment in the renal unit – and have managed to keep most of my sodium/potassium/phosphate levels in control. Because (up until now) the gout has been sporadic, I haven't really explored “gout diet” issues with the dietician (I will next time!)
Just wondering if anyone else is in the same boat and can advise how I can safely adapt my diet until I next see the dietician.
Many thanksOctober 30, 2011 at 8:55 am #12221
Not many of us are fond of dietary control for gout. It just doesn't work (as witness your two attacks a year.)
Your case is very special and all recommendations MUST be run by an excelllent nephrologist.
A couple thoughts: Uric acid is hard on the kidneys so a regimen to lower uric acid seems beneficial for both your end-stage kidneys and your gouty joints. What levels of serum uric acid do you run? Have you or your doctors ever given thought to long term uric acid management with drugs, proablably allopurinol.)
I don't think allopurinol is contra-indicated, in fact it may be quite desirable.
As an aside, before the developlent of urate lowering drugs, gout was a slow death sentence and the ususal route was by kidney destruction.
Are you planning long term dialysis or kidney replacement? A dear friend is on her 25th year with a cadaver kidney but the downside has been a life of cyclosporine that is starting to rear its ugly head. They suspect it is the cause of her macular degeneration with encroaching blindness. Talk about damned if you do and damned if you don't.
And of course whatever route you choose will turn EVERYTHING on it's head, becasue your whole liquid excretion system will be changed. You'll need a whole new set of recommendations.October 31, 2011 at 5:23 am #12228
Thanks zip – I realise I can't cure it by diet – I was just hoping for suggestions to hold it at bay or at least stop it from getitng any worse until I see my nephrologist at the end of November. My GP is understandably reluctant to prescribe anything as he doesn't want to interfere with the renal unit's carefully balanced drug cocktail I already take.
Looking at some of my old blood results I don't see uric acid levels listed. Only what I think is Urea (listed as URE) which is 19.6. I'll see if I can get it tested before my hospital appointment (but hopefully after this attack has settled) so the nephrologist can see what he's working with.
I did knock up a batch of black bean soup and had it with my phosphate binders, not too bad. On the whole I reckon if the “bad for kidney” foods clash with the “good for gout” foods I should err on the side of looking after what's left of my kidneys first.
For now I'm just carrying on regardless – avoiding beer etc. I've got some black beans in stock now – and although I eat very few pulses I'll have them in preference to other types when I do. Likewise, although I'm on limited fruit – I'll keep cherries towards the top of the list. Can't hurt, and at least I know they're unlikely to make matters worse.
As far as I know allopurinol is Ok for kidneys, but colchicine is not great for them, I'll let you know how I get on.
I'm hopefully having a pre-emptive live donor transplant – I was expecting to have had it by now, but my kidneys are hanging in there a bit better than expected, so I'm still in limbo – but glad of it.
Thanks for the advice
Mrs TOctober 31, 2011 at 9:03 am #12231
Urea is VERY different from uric acid despite the similar names.
So then it's possible the Stage 5 might have been an overkilll call and you are hanging at Stage 4 (or 3)…that would be good.
So your 2 orders of business then are getting a uric acid reading…I'm AMAZED they haven't done any to date… and getting the nephrologist okay on allopurinol.
Thanks zip – I realise I can't cure it by diet
It's worse than that; you cannot even CONTROL it with diet. Diet was for a time a half century ago when there was nothing that could be done for gout except pain mitigation.October 31, 2011 at 9:25 am #12233
I've been hovering around the stage 4/5 borders for about 18 months with EGFR's of between 11 and 16. All my paperwork lists me as stage 5. I was initially pencilled for transplant before last Christmas, and again in March but have held things at bay by religiously taking my drugs, moderate exercise, plenty of sleep and refusing to get stressed about anything. Sorting my horrendous anaemia also helped – it's possible my iron levels are now a little on the high side – that'll need checking next time too along with the uric acid.
I imagine it's never been checked as I've never made too much fuss about the gout – it's tended not to coincide with my nephrologist visits so it's taken second place. I was always more worried about the anaemia, as it got so bad I could barely breathe or compose a sentence. That's fine now, and I can tackle the gout!
Dietwise – as long as I don't make it any worse I'm on the right track.