Gouty kidney disease: a tubulointerstitial paradigm reimagined-early detection, precision stratification, and targeted intervention.

Gouty kidney disease is a subtype of chronic kidney disease (CKD) featuring tubulointerstitial injury caused by urate crystal deposition. Conventional assessments using eGFR and albuminuria cannot detect early tubular damage. Risk stratification tools specific to this condition are lacking. We performed a comprehensive literature search from January 2000 to June 2026 across PubMed, Scopus, Web of Science, DOAJ, CNKI, and Wanfang Data. Keywords included gouty kidney disease, tubular biomarkers, SGLT2 inhibitors, and risk stratification. Renal resistive index (RI), urinary α1-microglobulin, and eGFR slope show potential for identifying early tubular injury. SGLT2 inhibitors provide renoprotective and mild urate-lowering effects relevant to gout-related CKD. The Tubular Risk Stratification (TRS) system is proposed as an exploratory, unvalidated conceptual model. A tubule-centred strategy may improve early detection and management of gout-related renal injury. If validated, the TRS system could support risk-stratified clinical care.