On a background of chronic kidney disease, which agent is preferred for an acute gout flare?

• A. Colchicine
• B. NSAIDs
• C. Allopurinol
• D. Prednisolone

Answer: (D)

In chronic kidney disease, managing an acute gout flare should avoid medications that can harm the kidneys while still controlling inflammation quickly. Nonsteroidal anti-inflammatory drugs are generally avoided in CKD because they can reduce renal perfusion and worsen kidney function. Allopurinol is used for long-term urate lowering, not to treat an acute flare, so it doesn’t help acutely. Colchicine can be used in CKD but requires careful dosing due to increased toxicity risk when kidney function is impaired. Corticosteroids provide effective anti-inflammatory relief without nephrotoxicity, making a short course of prednisolone a preferred option for an acute gout attack in someone with CKD. A typical approach is a short course of oral prednisolone (for example, 0.5 mg/kg/day for 5–7 days, then taper), or an equivalent regimen, with monitoring for side effects.