Uro-Metabolic Phenotype of Gout: Urine Acidity, Urate Crystalluria, and Renal Function as Markers of Severity and Systemic Inflammation
Keywords:
gout, hyperuricemia, urinary syndrome, urine pH, urate crystalluria, eGFR, systemic inflammation, CRP, SII, phenotyping, ROC analysisAbstract
Gout is a metabolic-inflammatory disease in which urate overload manifests not only through joint symptoms but also through changes in the urinary environment: decreased pH, increased specific gravity, and the formation of urate crystalluria. The clinical significance of these available markers for gout phenotyping and severity assessment has been poorly studied. To evaluate the clinical significance of urinary syndrome indicators and urate crystalluria in patients with gout and determine their relationship with disease activity, renal function, and systemic inflammation. A single-center, controlled observational study was conducted (2021–2025, Urgench outpatient clinic). The analysis included two groups: patients with gout (n=203) and apparently healthy individuals (n=109). At the baseline visit, urine pH and specific gravity, leukocyturia, microhematuria, proteinuria, urate crystalluria and its severity, as well as SUA, creatinine, eGFR, CRP, and SII were assessed. Statistical analysis included nonparametric comparisons, correlation analysis, multivariate logistic regression, and ROC analysis (p<0.05). Patients with gout had a distinct urometabolic profile: lower urine pH, higher specific gravity, and a significantly higher incidence of urate crystalluria compared to controls (p<0.001). Crystalluria and low pH were associated with greater clinical gout activity, less favorable renal function (eGFR), and more severe systemic inflammation (CRP, SII). In multivariate models, urinary syndrome parameters maintained an independent association with adverse phenotypes (tophaceous/frequently recurring course and/or decreased eGFR). ROC analysis confirmed the clinically significant discriminatory ability of key urinary markers for identifying patients at risk. Urinary syndrome parameters in gout reflect urate overload and form a urometabolic phenotype associated with the severity of the clinical course, inflammatory activity, and renal function. Available parameters of pH and urate crystalluria can be considered practical tools for phenotyping and risk stratification in patients with gout.
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