A 55-year-old man with gout has serum urate of 9.8 mg/dL and has had 3 attacks in the past year. He also has CKD stage 3. What is the serum urate TARGET recommended during urate-lowering therapy according to current guidelines?

• A < 7 mg/dL (< 420 µmol/L)
• B < 5 mg/dL (< 300 µmol/L) only for tophaceous gout
• C < 8 mg/dL (< 480 µmol/L) in CKD patients
• D < 6 mg/dL (< 360 µmol/L) ✓

Explanation

ACR 2020 and EULAR guidelines for gout recommend a serum urate target of <6 mg/dL (360 µmol/L) for all patients on urate-lowering therapy, to promote urate crystal dissolution and prevent recurrent attacks. A stricter target of <5 mg/dL (300 µmol/L) is recommended for tophaceous or severe gout to accelerate tophus resolution. CKD does not modify this threshold upward — allopurinol remains first-line but must be dose-adjusted.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.