Nephrology Board Review Sample Questions

The correct answer is B. Allopurinol and stopping Hydrochlorothiazide

Explanation: The first line treatment for recurrent gout allopurinol. It can be given in chronic kidney disease, it actually may have added benefit to the patient with chronic kidney disease or congestive heart failure. In this patient, she is also on a medication that increased uric acid levels, hydrochlorothiazide. She would most likely be best managed by discontinuing hydrochlorothiazide and possible starting on calcium channel blocker or losartan since they are associated with decreased risk of gout.

Not Colchicine and continuing Lipitor. Colchicine is not the first line for gout and should be adjusted for chronic kidney disease. Additionally, there is a rare risk of rhabdomyolysis with colchicine and statin use.

Not Probenecid and stopping Hydrochlorothiazide. Stopping hydrochlorothiazide is the correct action however probenecid is not the first line medication for gout, it is typically used as a second line treatment because of its interactions with other medications.

Not Allopurinol and continuing Hydrochlorothiazide. Allopurinol is the correct agent for treatment however hydrochlorothiazide could be contributing to the increased bouts of gout, thus this should be discontinued.

Not Pegloticase and stopping Hydrochlorothiazide. This an IV medication that is third line for refractory gout, it is administered every 2 weeks by rheumatology and extremely costly, so it would not be first line.