Question

A 45-year-old with poorly controlled gout (3 flares in 6 months) has serum urate 9.0 mg/dL and eGFR 55 mL/min/1.73 m². Best initial urate-lowering therapy approach?

Accepted Answer

Start allopurinol ≤100 mg/day (≤50 mg/day in CKD) and titrate to target urate <6 mg/dL

Answer

Start allopurinol 300 mg daily immediately

Answer

Start febuxostat 80 mg daily first-line in CKD

Answer

Start probenecid 1 g BID first-line in CKD

Answer

Avoid ULT; treat flares only

Practice question

A 45-year-old with poorly controlled gout (3 flares in 6 months) has serum urate 9.0 mg/dL and eGFR 55 mL/min/1.73 m². Best initial urate-lowering therapy approach?