[Gout nephropathy--ghost or reality?].

Until the past decades, end stage renal disease was considered a major cause of death among patients with gout. Modern long-term follow up studies of renal function however have indicated that hyperuricemia and gout rarely result in kidney damage unless other renal diseases supervene. Subsequently, the use of the EDTA lead mobilization test confirmed that gout in the presence of chronic renal failure is a useful marker of chronic lead intoxication. Chelation treatment with EDTA can slow the progression of renal insufficiency, without apparent damage associated with the use of the chelating agent. Since chronic lead intoxication may remain clinically concealed for years, a high index of suspicion is warranted. Occult lead intoxication should be sought actively in gouty patients with chronic renal insufficiency of unknown etiology.