Non-alcoholic fatty kidney disease (NAFKD): A novel disease that explains the etiology of hyperuricemia and gout in metabolic syndrome

Gout is the most common inflammatory arthritis in adults. It is causally associated with intraarticular deposition of monosodium urate crystals in hyperuricemia. The commonest pathogenesis is renal under-excretion of urate in metabolic syndrome. Despite being the commonest type, the exact etiology of hyperuricemia in metabolic syndrome remains unclear. Historically, common gout was found at increased rates in affluent men, earning its name the ‘disease of kings’. It is also rare in premenopausal women. The authors hypothesize that the etiology of common gout is a novel condition termed non-alcoholic fatty kidney disease (NAFKD). The hypothesis offers an explanation of the two prerequisites necessary for the development of NAFKD (that leads to hyperuricemia and gout) as follows: 1) sustained positive energy balance and 2) male sex hormone predominance state. The hypothesis presented herein could guide the prevention and early detection of hyperuricemia and support curative modalities.