A 58-year-old man with recurrent gouty arthritis and stage 3 chronic kidney disease (eGFR 45 mL/min/1.73 m²) requires long-term urate-lowering therapy. Which agent is the most appropriate first-line choice?
- A Allopurinol ✓
- B Probenecid
- C Febuxostat
- D Pegloticase
Correct answer: A. Allopurinol
Explanation
Allopurinol is the first-line xanthine oxidase inhibitor for urate-lowering therapy in patients with chronic kidney disease, with dose adjustment according to renal function. Probenecid is a uricosuric agent that is ineffective when creatinine clearance is low. Febuxostat is an alternative xanthine oxidase inhibitor but is reserved for patients intolerant to allopurinol due to cost and potential cardiovascular safety concerns. Pegloticase is a recombinant uricase reserved for refractory tophaceous gout.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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