Walk into the Clinical Blood Sciences lab at Croydon University Hospital and you can’t miss them: a pillar covered in laminated wall charts, each one a grid of red and green marker strokes climbing towards a 95% goal line. They track urgent turnaround times for tests like troponin, U&Es and CRP, day by day, month by month. They’re simple. They’re visible. And according to the team behind them, they’re changing how the lab works.
Urate
| Category | Biochemistry |
|---|---|
| Turnaround time | Daily |
Additional information
Reference range – male: 200 – 430 Micromol/L
Reference range – female: 140 – 360 Micromol/L
Gout management
In recurrent clinical gout increase allopurinol to a target serum urate of <360 umoL or 300umol for persistent flares or in tophaceous gout.
See NICE gout guidelines.
Treatment with Allopurinol is first line and should be started at 100mg per day and titrated up based on serum urate levels (steady state reached at 4 weeks).
The usual dose needed is 300mg but doses up to 900mg/day may be needed (dose over 300mg should be given in divided doses)
Consider prophylaxis with colchicine 500mcg od-bd for up to 2-3 months while instituting Allopurinol therapy unless contraindicated.
Allopurinol dose in renal impairment. GFR ml/min (The Renal Drug Handbook 5th edition ).
GFR ml/min: 20-50 Allopurinol 200-300mg/day
10-20 Allopurinol 100-200mg/day
<10 Allopurinol 50 -100mg/day 100mg alternate days
Colchicine dose adjustment in renal impairment. GFR ml/min (The Renal Drug Handbook 5th edition/Renal Drug Database accessed Sept 2022):
GFR ml/min: 20-50: Reduce dose to 500mcg od.
10-20: Reduce dose to 500mcg once a day
<10: seek rheumatology/renal advice
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