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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 64-year-old man with a 35-year history of recurrent nephrolithiasis and progressive development of chronic kidney disease&#44; presently in stage 3&#46; Since he had begun to experience colic&#44; he had had recurrent episodes of monoarthritis in lower limb joints&#44; more marked in the knees&#44; where signs of advanced arthrosis had already appeared&#46; As the findings were suggestive of gouty arthritis&#44; he was treated with colchicine&#46; A few years later&#44; the kidney stones were found to be composed of uric acid and hyperuricemia of approximately 10<span class="elsevierStyleHsp" style=""></span>mg&#47;dL was detected&#46; The patient was recommended to drink abundant liquids and to take potassium citrate&#44; together with dietary measures and allopurinol&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In our examination&#44; we observed hard&#44; painless nodules in proximal interphalangeal joints that&#44; when pressed&#44; showed slight mobility &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#59; black arrows&#41;&#44; independent of the underlying bone&#44; and were radiolucent &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#59; yellow arrows&#41;&#46; The patient could not remember when they had appeared for the first time&#46; The pathological study of a specimen from one of the nodules that caused him discomfort revealed urate deposits among fibrous bridges &#40;10&#215;&#41;&#46; At a greater magnification &#40;60&#215;&#41;&#44; the remains of uric acid crystals in the form of thin parallel fibers can be discerned&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient has a classical syndrome caused by untreated chronic hyperuricemia&#46; It is characterized by the successive development of uric acid stone formation&#44; gouty arthritis&#44; tophi and urate nephropathy &#40;interstitial or secondary to stone formation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> The tophi in this patient in particular must be distinguished from the Heberden and Bouchard nodes found in other degenerative inflammatory nephropathies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Hyperuricemia is highly prevalent and is related to other also common disorders&#44; such as hypertension and the metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> However&#44; what is not so common is to see such florid clinical manifestations&#44; since detection and treatment take place in increasingly earlier stages of the disease&#44; especially in individuals with comorbidity&#46; This patient&#44; who had no other medical history of interest&#44; was not diagnosed on time and exhibited the natural course of the disease&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Hyperuricemia and its clinical signs generally have an insidious and benign behavior&#44; which responds favorably to treatment&#46; For this reason&#44; early detection and proper treatment are essential in the prevention of progression toward its most serious complication&#58; uric acid nephropathy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Author Contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Manuscript conception and design&#58; Fernando Macaya&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Data collection&#58; Fernando Macaya&#44; Isaac D&#237;az&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; Fernando Macaya&#44; Isaac D&#237;az&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Writing&#44; revision and approval of the submitted manuscript&#58; Alejandro Adrover&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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