Q: 58 year old male with end stage renal disease (ESRD) developed  acute gout. All of the following can be used except

A) Glucocorticoids
B) NSAIDs 
C) Colchicine
D) Proton pump inhibitors (PPIs)
E) Acetaminophen 



Answer: C

Colchicine should be avoided in ESRD patients even if they are on hemodialysis as colchicine does not get removed by hemodialysis. Patients may develop toxicity fairly quickly. Glucocorticoids in any form i.e  intraarticular, oral or parenteral is the first line of treatment in these patients, which is in contrast to non-renal patients. Once patient is on hemodialysis NSAIDs should be ok to use in mild to moderate attacks. PPIs and acetaminophen have no contraindications in gout.