Last updated: October 26, 2026
Medically reviewed by: NKF Patient Education Team
Gout and kidney disease are closely linked. Learn what causes gout, signs of a gout flare, how gout is diagnosed and treated, and why checking your kidney health is important.
About gout and kidney disease
Gout is a type of arthritis that can cause sudden pain, swelling, and redness in a joint. It happens when uric acid builds up in the blood and forms crystals in or around a joint.
Uric acid is a waste product made when your body breaks down substances called purines. Purines are found naturally in your body and in some foods.
Your kidneys help remove uric acid from your blood through your urine. When kidney function goes down, your kidneys may have more trouble removing uric acid. This can cause uric acid to build up and increase the chance of gout.
This is why gout and chronic kidney disease, also called CKD, are closely connected. People with CKD have a higher risk of gout, and people with gout are also more likely to have CKD.
CKD can also affect which gout medicines are safe for you and how much medicine you should take. Gout and CKD also share several health risks, including high blood pressure, diabetes, heart disease, and obesity.
If you have gout, knowing your kidney numbers can help you and your healthcare team choose the right treatment. eGFR and UACR show how well your kidneys are working.
Signs and Symptoms
Gout often causes a sudden attack of pain called a gout flare. A flare can start quickly and may be very painful.
Signs of a gout flare can include:
- Severe joint pain
- Swelling
- Redness
- Warmth around the joint
- Tenderness
- Trouble moving the joint
More than half of people with gout get their first gout attack in a big toe (called podagra), and most people will get it there at some point during the disease. Although gout often affects the big toe, it can also affect the ankles, knees, feet, hands, wrists, or elbows.
A flare may get better and then return later. Without treatment, gout can become more frequent and affect more joints.
Talk with your healthcare professional if you have sudden or severe joint pain, especially if the joint is red, swollen, or warm.
Causes of gout
Gout happens when uric acid in the blood becomes high enough for uric acid crystals to form.
Your uric acid level can rise if:
- Your kidneys do not remove enough uric acid
- Your body makes too much uric acid
- Certain medicines raise your uric acid level
- You have certain health conditions
- You become dehydrated
- You regularly eat or drink large amounts of foods or drinks that can raise uric acid
Family history can also affect your risk.
High uric acid can cause gout in people. However, having a high uric acid level does not always mean you will develop gout. Some people have high uric acid but no gout symptoms.
Types of gout
Gout can change over time. Some people have sudden gout flares, while others develop ongoing gout problems after years of high uric acid.
Acute gout
Acute gout means a sudden gout flare. It can cause severe pain, swelling, redness, and warmth in one or more joints. A flare may last for several days or longer.
Gout between flares
After a gout flare ends, you may feel better and have no symptoms for a while. This time between flares is sometimes called intercritical gout.
Even when you do not have pain or swelling, uric acid crystals may still be present in your joints.
Chronic gout
Chronic gout happens when gout continues over time and causes ongoing problems. Flares may happen more often, more joints may be affected, and joint damage can develop.
Some people with chronic gout develop tophi, which are hard lumps made of uric acid crystals that build up under the skin or around joints. This is sometimes called chronic tophaceous gout.
Chronic uncontrolled gout
Chronic uncontrolled gout (also called refractory gout) is a rare form of severe gout. Both gout and chronic uncontrolled gout are very painful, but chronic uncontrolled gout more often leads to serious problems like permanent joint damage and trouble with moving and walking. It may not go away with standard treatments. Other medicines may be needed. People with chronic uncontrolled gout can also have problems with their kidneys.
Complications
Gout can cause problems when it is not treated or is not well controlled.
These can include:
- More frequent gout flares
- Pain that affects more joints
- Joint damage
- Trouble moving or doing everyday activities
- Hard deposits of uric acid under the skin called tophi
- Kidney stones
Tophi usually develop after uric acid has been high for a long time. They may form around joints, fingers, elbows, toes, or ears.
Uric acid can also form crystals in the urinary tract and cause kidney stones.
Diagnosis and testing for gout
Your doctor will ask about your symptoms, health history, medicines, and family history. Your doctor will also look at the painful or swollen joint. Several tests may help confirm gout, rule out other causes of joint pain, and guide treatment.
Uric acid blood test
Is a blood test that measures the amount of uric acid (sUA) in your blood. A high uric acid level can support a gout diagnosis, but it does not always mean you have gout.
Uric acid levels can change during a gout flare. Your doctor may check your level again after the flare improves to get a clearer picture.
Joint fluid test
A joint fluid test is when a doctor may use a needle to remove a small amount of fluid from the swollen joint.
The fluid can be checked for uric acid crystals. Finding these crystals can confirm gout. This test can also help rule out other causes of joint pain and swelling, such as an infection.
Imaging
Imaging may be used when it is not clear whether gout is causing your symptoms. An ultrasound or another imaging test may show uric acid crystals, swelling, or joint damage caused by gout over time.
Kidney tests
If you have gout, ask about testing for kidney disease.
Two important kidney tests are:
- eGFR, a blood test that shows how well your kidneys filter your blood
- UACR, a urine test that checks for albumin, a type of protein that can be a sign of kidney damage
Tracking Labs
You can speak to your healthcare team about access to your lab results (printout or online access, depending on the practice). You may also be able to directly access your lab tests straight from the lab.
You can also track your serum uric acid (sUA) level (amount of uric acid in your blood), estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio using the online Gout and Uric Acid Tracker, or by printing out the PDF version.
Treatment for gout
Gout can be treated. Treatment has two main goals:
- Treat the pain and swelling during a gout flare
- Lower uric acid over time to prevent future flares and other problems
Your treatment plan will depend on your symptoms, uric acid level, kidney function, other health conditions, and medicines you already take.
Treating a gout flare
Medicines can help reduce pain and swelling during a gout flare.
These may include:
- Colchicine
- Corticosteroids
- Nonsteroidal anti-inflammatory drugs, also called NSAIDs, are used to help with pain and inflammation with gout. However NSAIDs like ibuprofen and naproxen are pills usually avoided in CKD.
If you have kidney disease, talk with your doctor or pharmacist before taking any over the counter pain medicine.
Lowering uric acid over time
Some medicines help lower the amount of uric acid in your blood. This can help prevent future gout flares and other problems from gout.
Medicines for lowering uric acid include allopurinol, febuxostat, probenecid, and lesinurad, which all pills. Pegloticase is given through a vein for severe gout that doesn’t get better with pills. Your doctor will choose the medicine and dose that are safest for you, especially if you have CKD.
Your doctor will check your uric acid level with a blood test. For many people with gout, the goal is to keep uric acid below 6 mg/dL.
You may need to take this medicine even when you feel well. Do not stop taking it unless your doctor tells you to.
For many people with gout, the uric acid goal is less than 6 mg/dL. Your healthcare team can tell you what goal is right for you.
Food and drinks
What you eat and drink can affect uric acid, but diet is only one part of gout treatment.
Some people may benefit from limiting:
- Alcohol, especially beer
- Organ meats
- Large amounts of red meat
- Some seafood
- Drinks and foods high in added fructose or sugar
Eating a healthy, balanced diet can also help manage conditions that often occur with gout, such as CKD, high blood pressure, diabetes, and heart disease.
Eating less animal protein like meat keeps the urine less acid, which may lower the risk for gout flares and kidney stones. Also, eat lots of vegetables and fruits. If you have CKD, your nutrition needs may be different. A registered dietitian who knows about kidney disease can help you build an eating plan that works for you.
Fluids
Drinking enough fluid (preferably water) can help lower the risk of dehydration and some kidney stones. However, some people with kidney disease need to limit how much fluid they drink.
Medicines and supplements
Some medicines can raise uric acid levels. Other medicines may need to be changed when kidney function is reduced.
Make sure your healthcare team knows about all prescription medicines, over the counter medicines, vitamins, and supplements you take.
Do not start an herbal supplement to treat gout without talking with your doctor or pharmacist. Some supplements can harm the kidneys or interact with your medicines.
Managing gout over time
Gout is a long-term condition, but it can be managed. Keeping uric acid at a healthy level can help prevent future flares and other problems.
Work with your healthcare team to:
- Know your uric acid level
- Know your eGFR and UACR
- Take your medicines as prescribed
- Talk with your doctor if you continue to have gout flares
- Review your medicines regularly
- Follow an eating plan that works for your gout and kidney health
- Manage other conditions such as high blood pressure, diabetes, and heart disease
Keep track of how often you have gout flares. Tell your doctor if flares happen more often, last longer, or make it harder to do everyday activities.
Some people continue to have gout flares, high uric acid levels, tophi, or joint problems even with treatment. If this happens, your doctor may need to change your medicine or treatment plan.
Preparing for your appointment
Before your appointment, it may help to write down:
- When your joint pain started
- Which joints are affected
- How often you have gout flares
- How long each flare lasts
- Your medicines and supplements
Questions to ask your healthcare professional
- What is causing my joint pain?
- What is my uric acid level?
- What should my uric acid goal be?
- How can I treat a gout flare safely?
- Do I need medicine to lower my uric acid?
- Are my gout medicines safe for my kidneys?
- Should any of my other medicines be changed?
- What are my eGFR and UACR results?
- How often should my uric acid and kidney function be checked?
- What foods or drinks should I limit?
- What should I do if I keep having gout flares?
Kidney health information, support, and professional resources
Learn more about kidney health
Explore more information and resources about kidney health.
- NKF Workshop Identifies Major Gaps in Gout Treatment and CKD Care
- Gout Isn’t Your Fault: What People With Kidney Disease Need to Know
- NKF Nutrition Hub
- Medicine and Kidney Health Hub
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