THE NEPHROPATHY OF GOUT*

GOUT may be succinctly defined as a disorder of purine metabolism char-acterized by hyperuricemia and a typical form of recurrent acute arthritis which often eventually is associated with urate deposits in cartilages, bone, joint spaces, bursae, tendons, kidneys and other tissues.1 Although the ex-istence of a "gouty nephritis " as a "complication " of this disease has long been recognized,2'3'4'5 the high incidence of renal damage and its true place as an integral part of the whole disease process do not appear to be generally appreciated. Careful study, however, reveals that the metabolic error in gout produces not only a form of arthritis but also, almost as frequently, a form of kidney disease. In one series of 77 cases of gout examined post mortem, only four patients were found to be without evidence of kidney disease.6 In another series of 65 cases carefully studied clinically 38, or close to 60%, exhibited some degree of renal disease, as evidenced by per-sistent albuminuria, erythrocytes and casts or nitrogen retention.5 The authors of earlier reports offer a variance of opinions on the incidence o