Analysis of the Causes and Preventive Measures of Misdiagnosis of Hypertensive Nephropathy as Gouty Nephropathy

LAN Qing; YU Haowei

doi:10.3969/j.issn.1002-3429.2025.11.003

Abstract：Objective To analyze the causes of misdiagnosis of hypertensive nephropathy as gouty nephropathy and to explore its preventive measures,in order to improve the differential diagnosis ability of clinicians and reduce the occurrence of misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 2 patients with hypertensive nephropathy who were initially misdiagnosed as gouty nephropathy and admitted from January 2021 to December 2023.Results One patient was misdiagnosed with gouty nephropathy due to joint pain in both knees and feet and hyperuricemia,and received treatment with non-steroidal anti-inflammatory drugs and Allopurinol,but the effect was not good.After being transferred to the Nephrology Department,proteinuria(++),increased urinary microalbumin and mild thinning of the renal cortex were found.Eventually,the patient was diagnosed with hypertensive nephropathy.The misdiagnosis lasted one week.After diagnosis,Enalapril and a low-salt and low-protein diet were adopted for treatment.During the 6-month follow-up,the blood pressure was stable,the renal function improved,and the symptoms disappeared.One patient was misdiagnosed with gouty nephropathy due to persistent dull pain in the waist and severe pain in both knees accompanied by hyperuricemia.After treatment with naproxen and allopurinol,the effect was far fro msatisfactory.After being transferred to the Nephrology Department and undergoing examinations such as urine routine and imaging,the characteristics of glomerular injury were found,and it was diagnosed as hypertensive nephropathy.The misdiagnosis lasted one week.After diagnosis,the treatment plan was adjusted to Losartan and a low-purine diet.During the 6-month follow-up,the symptoms disappeared and renal function remained stable.Conclusion The symptoms of hypertensive nephropathy are complex and easily confused with gouty nephropathy.When clinicians encounter similar patients,they should inquire about the medical history in detail,especially whether there is a history of hypertension.A comprehensive judgment should be made in combination with laboratory and imaging examinations to reduce the risk of misdiagnosis.