Probenecid is considered as urate-lowering therapy in a patient with gout. Which feature in his history makes probenecid an inappropriate choice?

• A History of recurrent calcium oxalate kidney stones ✓
• B Concurrent hypertension treated with losartan
• C Tophi over the olecranon bursa
• D Serum urate of 9 mg/dL despite dietary measures

Explanation

Probenecid is a uricosuric that blocks reabsorption of urate via URAT1 and OAT transporters in the proximal tubule, increasing urinary uric acid excretion. This raises urate concentration in tubular fluid and urine, so it is avoided in patients with a history of urolithiasis and in those who are marked urate overproducers or have tophi. Losartan is mildly uricosuric itself and is not a contraindication.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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