chemo, gout and kidney stones

[mackswife]

About 3 weeks ago my DH developed an acute, raging case of gout in his ring finger. PCP started a prednisone dose pack and colchicine. Onc said chemo could cause a flare up of gout if one was "predisposed". DH has a past history of pseudogout (not caused by high levels of uric acid like "regular" gout). Severe inflammation continued, despite the doses of decadron received during the last two chemo rounds. A referral to a hand surgeon followed...daily dose of prednisone ordered and gout confirmed. Well, yesterday evening, DH had sudden onset of back pain and projectile vomiting. After vomiting the back pain would be relieved for a time. That cycle continued three times and then we went to the ER. Yep, 3 kidney stones were found on CT scan with the largest being 8 mm and too large to pass. Pain was relieved with IV meds and we returned home. DH will start folfox round 8 Monday, then head over to consult with a urologist. I know that dehydration is a contributing factor in the development of kidney stones, and Dr. Google has many reports that state chemo can raise the levels of uric acid which cause gout, and can cause stones to develop.

Has anyone else had a similar experience with these issues on chemo. DH does not want to postpone any rounds of chemo unless absolutely
necessary because he "just wants to get on the other side of it". But, he can't be walking around waiting for the next renal colic attack to
happen either. I know it will all work out, but I would appreciate any thoughts or advise you all might have.

[Marrya]

Hi there, I think you can ask his oncologist to check his uric acid level. There is a medication that oncologists give to chemo patients to prevent elevations of uric acid and they can give him that. In addition dietary changes like less meat can also bring uric acid down, you can do more research about that. Sorry don't know too much about it.

[EdFromCT]

Although I didn't have any kidney stones to my knowledge, I developed debilitating gout about midway into chemo. I had some rare flare-ups previously, but nothing like this. It affected my feet very painfully and later my ankles, and eventually even caused edema in the ankles. By then I couldn't walk without using a pair of trekking poles for support, although I could still get around with them well enough to work. My oncologist was initially reluctant to treat me for gout, and he seemed a little skeptical that something else might be going on instead. But he eventually relented and got me an emergency appointment with a rheumatologist, who verified my self-diagnosis and said that this is a pretty common problem, although it's usually not so extreme. An x-ray even showed some bone damage to the toes. She prescribed a rather complicated graduated treatment regimen involving prednisone, colchicine, and allopurinol. It worked! Things were dramatically better after a week, and cleared completely in a few weeks.

After chemo ended, I was able to cut the allopurinol dosage to one 100 mg tablet every other day, and eliminate everything else. However, it looks like I'm permanently more prone to gout than before, so I'm probably stuck with this low-dose regimen pretty much indefinitely. By the way, don't take aspirin for gout! It tends to make things worse, and probably wouldn't be approved during chemo by most oncologists anyhow.

So yes, this sort of thing happens to others, and at least for me the solution was to talk to a specialist who was familiar with treating gout in chemotherapy patients.

-Ed

[tammylayne]

I also developed gout while on chemo. It was my husband that notice that on about day 7 of my 14 day cycle my knee woudl start to hurt. By day 12 I could hardly go up and down he stairs. Once I was about half way through my off week, I would start to feel better...then it would start all over again with the next cycle. I am happy to say that when chemo ended, so did the gout. I was told it isn't common, but can happen. It hurt!! He also said it may never bother me again...i will have to wait and see.

Good luck to your husband.

[Ron50]

I had a family history of gout that was noted well before ca and chemo tho I ever suffered from gout attacks. After chemo my uric acid levels rose even tho I was on allopurinol for many years. I developed and passed several lots of kidney stones. They were always accompanied by blood in my urine and my nephrologist thinks they have all been small but sharp uric acid stones. I have also had my gallbladder removed because of stones but they were all cholesterol stones. Referring to my last two blood tests my uric acid and urea levels are still in the red at 14 years post ca. Ron.