Familial urate nephropathy.

This report describes a family with the rare combination of tophaceous gout and renal failure. We emphasise that asymptomatic hyperuricemia may be associated with significant renal disease and suggest that in addition to tubular atrophy and interstitial fibrosis, both obstructive glomerular and tubular lesions and also vascular lesions are important in the pathogenesis of urate nephropathy. We recommend that potentially affected family members should be actively sought and treated at an early age in the hope of preventing the development of renal failure.