Gout - Uric acid deposits in the joints and surrounding tissues due to kidney damage cause gout.

There is
difficulty in movement with red and swollen joints.

Gout is a musculo-skeletal disorder affecting the muscles and bones around the joints of the mammals
and bird. It is a common disease among humans and reptiles, and is also seen in birds, especially
budgies, waterfowl and poultry

Etiology

Although some instances of gout are hereditary, others may be aggravated by environmental or
nutritional factors. Gout is mainly due to damaged kidneys (nephropathy). When they stop functioning
normally, it results in an accumulation of uric acid and urates in the muscles and joints. Kidney damage
leading to gout can be due to the following causes

High calcium and vitamin D3 with low phosphorus amounts in food.

High amount of salt (> 0.3%) in food.

Not enough water in the diet (dehydration)

High amount of sodium bicarbonate in food.

High amount of protein (>30%) in food.

Viral infection like Avian nephritis

Consumption of water with a high amount of minerals (Ca & CuSO4)

Poisoning by disinfectants (i.c. cresol, phenol)

Antibiotics like gentamicin, nitrofurosones and sulfonamides

Pathogenesis

Uric acid is one of the end breakdown products of dietary protein in bird and other animals.

The uric acid is removed from the blood by the kidneys and excreted in the urine.

Gout can occur if the level of uric acid (a by-product of the breakdown of dietary proteins usually
excreted in the urine) in the blood exceeds the ability of the kidneys to remove it.

In articular or synovial gout, the uric acid crystallizes in the joints, ligament and tendon sheaths.

In visceral gout, uric acid deposits are found in the liver, spleen, pericardial sac, kidneys and air sacs.

When the uric acid crystallizes in tissues it forms small, white nodules called "tophi."
Symptoms

There are two types of gouts, and symptoms depend on the type on which bird is affected.

Articular gout

Male birds are generally susceptible to articular gout and the common age for this affliction is four
months and above.

The joints may be enlarged, stiff and painful and warm to touch.

Shifting of weight from one foot to the other and shuffling gait.

Inability to perch, spending most of the time on the floor of the cage.

If the wings are affected, the bird may be unable to fly.

If forced to walk the bird becomes noisy due to discomfort.

Depression, dullness and dehydration with greenish diarrhea.

Visceral gout

Visceral gout occurs in the tissues of the internal organs and if the internal organs are involved, signs
include: Weight loss, Decreased appetite, Lethargy, Abnormal droppings, Change in temperament

Diagnosis

Diagnosis of gout involve analyzing the diet, environmental factors, availability of fresh, clean water and
a thorough history of previous health problems and treatments.

Examination of x-rays, blood tests, joint fluid or biopsy samples are required for diagnosis.

Uric acid crystals in joint fluid and tissues will confirm the diagnosis.

Treatment

Treatment depends greatly on underlying cause of gout. However, following management can be
suggested

If the bird is dehydrated, administration of fluid orally or parentally is required. If the cause of gout is
due to improper nutrition, supply low protein diet and may supplement with vitamin A.

Urinary acidifiers should be administered to decrease the uric acid.

Reducing proteins, calcium, vitamin D3 and salt, in-combination with an increase of phosphorus and soft
water intake are all important dietary changes to treat gout.
The drug allopurinol or probenecid or colchicines which decreases the amount of uric acid produced in
the body. But the exact dosage and safety of these drugs in birds have not been determined.

A feed analysis is also necessary, ensures the bird receives an appropriate intake of minerals, protein
and vitamins Multivitamins including vitamin K may be used to help the liver and kidneys function
normally and can help control the Most birds with gout must be treated for the rest of their lives. If
therapy is discontinued, there is a possibility that the disease will reappear if the therapy is discontinued

Although there is no cure for gout, it's important for every bird owner to keep an eye out for symptoms,
while also providing proper nutrition, an adequate source of vitamin A, either from leafy, green
vegetables or vitamin supplements and fresh clean water.

Gout in birds

Gout is a condition in which crystals of uric acid (UA) or urates are deposited in tissues. Uric acid is the
relatively water- insoluble nitrogenous end product of protein and purine nucleotide metabolism. Gout
is a common discase among humans, reptiles and birds. It is more common in budgies, waterfowl and
poultry

What causes gout?

Uric acid is one of the end breakdown products of dietary protein in birds and other animals. The uric
acid is removed from the blood by the kidneys and excreted in the urine.

Gout can occur if the level of uric acid in the blood exceeds the ability of the kidneys to remove it.

Excessive levels of uric acid, slightly soluble in the blood (uriaciduria) may lead to the formation of
insoluble salts (urates).

Types of gout

A. There are two types of gout based on etiology, viz. 1. Primary gout and 2. Secondary gout

Primary gout

In primary gout, the high uric acid level is a result of an abnormal breakdown of protein.

Secondary gout - In secondary gout, the high level is due to the inability of the kidneys to adequately
excrete the uric acid.

This can be caused by medications, chronic diseases, kidney diseases, overeating, improper diet (high
protein and possibly high vitamin D or low Vitamin A), poor blood circulation, inactivity, decreased water
intake or chronic dehydration, some infections, and other environmental factors which affect the
kidneys' ability to eliminate uric acid.
B. There are two types of gout based on lesions produced, viz. Visceral gout and Articular gout.

Visceral gout - Uric acid deposits are commonly found in the serous membranes of visceral organs
especially in the liver. spleen, pericardial sac, kidneys and air sacs.

Articular (synovial) gout- The uric acid crystallizes in the joint, ligaments and tendon sheaths. When uric
acid crystallizes in tissues it forms small, white nodules called ‘tophi’

Factors associated with gout in these species include: impaired renal function and clearance of urates,
nephrotoxic drugs, various dietary excess (protein and calcium), and deficiencies (vitamin A) and
dehydration.

The kidney damage can arise from infection with certain strains of Infectious bronchitis virus (IBV),
exposure to some mycotoxins or inadequate water intake.

Baby chick nephropathy in the first week of life (kidney damage) can be due to inappropriate egg
storage conditions, excessive water loss during incubation or during chick holding/transport, or
inadequate water intake during the first few days of life.

Very low humidity in brooding will also increase the likelihood of this problem.

in Pekin / mallard ducks the condition is almost always due to inadequate water intake, whereas in
muscovy ducks it is seen in breeders allowed to continue laying for over 24 weeks without a rest.

Pathogenesis of pain

The predilection site in humans includes articular and peri-articular tissues, where the urate crystals
attract and are phagocytized by neutrophils and macrophages. These cells release lysosomal enzymes
and mediators of inflammation, which, in turn, exacerbate the acute inflammation and cause intense
pain. Articular gout is stubbornly recurrent in human patients.

Clinical findings

Joint may be enlarged, stiff and painful and the bird may continually shift weight from one foot to the
other and have a shuffling gait. The bird may be unable to perch and so remains on the floor of the cage.
If the wings are affected, the bird may be unable to fly.

If the internal organs are involved, there may be a decrease in appetite, lethargy, weight loss and
abnormal droppings. The bird may show a change in temperament or die suddenly.

Diagnosis
Based on history of diet, environmental factors, availability of water and previous health problem and
treatment.

Based on necropsy lesions which include chalky white nodular deposits known as 'tophi" on
pericardium, liver, air sac, peritoneum. Similar deposits may be present in joints and are usually present
in the kidney.

The serous surfaces of visceral organs, especially the parietal surfaces of pericardium are encrusted by a
thin layer of grayish granular material that may have a metallic sheen and this appearance is enough to
make a diagnosis.

Radiographs and blood tests for uric acid help to substantiate the diagnosis.

The identification of uric acid crystals in joint fluid, biopsies or "tophi' confirms it.

Treatment

Any underlying dietary or environmental cause will need to be remedied. Birds with gout will be placed
on a low protein diet.

Vitamin A may be given to birds who had received an improper diet. Proper hydration is necessary and
fluids may need to be administered. Medications such as allopurinol. probenecid or colchicine may be
used but the exact dosage and safety of these drugs in birds have not been determined,

Most birds will need to be treated for life or the condition will quickly reappear if therapy is
discontinued.

Differences between visceral gout and articular gout in birds (21-23,31,44)

S/N

Features

Visceral gout

Articular gout
Onset

It is usually an acute condition but can be chronic

It is usually a chronic disease

Frequency

It is very common

It is rare or sporadic

Age

I day and above

4-5 months and above

Sex

Both males and females are susceptible

Mostly males

Main causes
• Dehydration

Nephrotoxicity-calcium, mycotoxins (ochratoxins. oosporein, aflatoxins etc.), certain antibiotics, heavy

metals (lead), ethylene glycol, ethoxyquin etc.

Infectious agents- nephrotropic IBV, avian nephritis virus (chickens), polyomavirus, PMV-1 (pigeons),
Salmonella sp.. Yersinia sp.. Chlamydia psittaci. Eimeria truncate, Cryptosporidia. Aspergillus sp.

• Vitamin A deficiency

• Urolithiasis

Neoplasia (lymphoma, primary renal tumors)

Immune mediated glomerulonephritis

Anomalies

Genetics

High protein in the diet

Others?

Pathogenesis (renal failure)

It is generally due to failure of urate excretion

It is probably due to a metabolic defect in the secretion of urates by the kidney tubules.

Gross lesions

Kidney

Kidneys are almost always involved and they look grossly abnormal with deposition of white, chalky
precipitates.
Kidneys are normal grossly. Kidneys may become abnormal with white urate deposits if the bird get
dehydrated.

Soft tissues

Visceral organs like liver, myocardium, spleen or serosal surfaces like pleura, pericardium, air sacs.
mesentery are commonly involved.

Soft tissues around the joints are always involved, especially feet. Other joints of the legs, wings, spine
and beak are also involved.

Joints

Soft tissue around the joints may or may not be involved. Surfaces of muscles, synovial sheaths of
tendons and joints are involved in severe cases.

Soft tissue around the joints are involved especially feet. Other joints of the legs, wing, spine and beak
are also commonly involved.

Microscopic

Generally no inflammatory reaction in synovium or visceral surfaces. Kidney has inflammatory reaction
around tophus

Granulomatous inflammation in synovium and other tissues.

If arthritis from gout is severe, it is possible to surgically remove the uric acid crystals from the joint. Pain
medications such as aspirin may be given. The prognosis for a bird with gout is generally poor.

Prevention Careful monitoring of the conditions of hatching egg storage and incubation with a view to
achieving a standard egg weight loss profile.

Humidification of holding rooms and chick transporters may also be beneficial.

(c) Gout in Poultry

Gout in poultry denotes a condition when there is a deposition of uric and urates in the organs of
poultry, because of increased concentration of uric acid in blood and body fluids as a consequence of
decrease excretion by the kidneys.

Forms of gout

There are two main forms of gout:

(i) Visceral gout

(ii) Articular gout.

In both the forms white chalky deposits occur. Articular form is a chronic form of the disease and it is
less common.

Etiology

Many factors may result in gout in poultry such as:

1 Excess of protein, especially protein of animal origin in the diet of poultry.

2 Deficiency of vitamin A.

(3) Disease involving kidneys.

(4) Specific diseases such as infectious bursal disease (IBD) or infectious bronchitis (IB) in chicks.

(5) Nephrosis due to overmedication with sulpha drugs or other kinds of medicines (Gentamycin and
nitrofurasone have to be carefully given. Ochratoxin and oosporin are important for disease production.

(6) Fungal toxins in the feed.

Some factors may help in aggravation of this condition such as extreme cold or humidity. Use of copper
sulphate in drinking water may result in water refusal, dehydration and gout. Disinfectants like phenols
and cresols if wrongly used also cause residual toxicity.

Lesions

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The kidneys appear swollen, mottled and greyish in colour due to deposition of urates. The ureters are
dilated with white, pasty material. In advanced cases whitish chalky deposits are also seen on the serous
membranes and surfaces of the liver, heart, etc.

Symptoms of gout

Gout is accompanied by signs of depression, dehydration and sometimes greenish diar- rhoea. Affected
chicks appear dull with ruffled feathers and moist vent. Mortality among chicks is high. Scarified chicks
show chalky deposits in kidneys, ureters and other organs.
Control of gout

• Avoid diet higher in proteins or high calcium.

• Review IB vaccination programme. In areas where IB is endemic, it is advisable to vaccinate chicks with
nephrotoxic strain at about 4 days of age. Day-one beak dip vaccination has been found useful in
broilers.

• Use urine acidifiers; Ammonium sulphate 5.0 g/kg and ammonium chloride 10 g/kg increase acidity of
urine and uric acid excretion. Methionine hydroxy analogue (MHA) or even DL methionine may be used.
• Meet the dietary calcium and phosphorus levels carefully. It is better to provide at least 50% Ca as grits
which dissolves slowly and maintains blood calcium level.

• Analyse the feed for mycotoxins particularly for ochratoxin and take necessary steps . Check water
supply for regular uninterrupted water supply and for proper heights of waterers.

• Examine if nephrotoxic drugs or disinfectants are being used or have been used. • Ensure proper levels
of A, B, D, K and B compiex.

Excessive use of sodium bicarbonate (more than 2 kg/ton) should be avoided. Use of electrolytes
through water may assist in controlling mortality.

In acute cases potassium chloride 1 g/litre can be used.

. Provide broken maize for at least 3 days along with Jaggary, 5 g per litre of water for 3 to 5 days in
acute cases with mortality.

Table 7.2 Differences between Visceral Gout and Articular Gout in Birds*
Visceral gout

1. Onset

It is usually an acute condition but can be chronic

2. Frequency

It is very common. 1 day and above.

3. Age

4. Sex

Both males and females are susceptible.

5. Causes

a. Infectious

b. Nutritional

c. Toxic
6. Pathogenesis

It is generally due to failure of urate excretion (renal failure).

7. Gross lesions (Kidney)

Kidneys are almost always involved and they look grossly abnormal with deposition of white, chalky
precipitates.

Soft tissues

Visceral organs like liver, myocardium, spleen or serosal surfaces like pleura, pericardium, air sacs,
mesentery, etc. are commonly involved.

8. Microscopic lesions

Generally no inflammatory reaction in synovium or visceral surfaces. Kidney has inflammatory reaction
around tophus.

Articular gout

It is usually a chronic disease.

It is rare or sporadic.

4-5 months and above. However, in immature, genetically susceptible chickens, it may be induced by
high protein levels in the diet.
Mostly males.

a. Genetic

b. High protein in the diet

c. Others

It is probably due to a metabolic defect in the secretion of urates by the kidney tutules.

Kidneys are normal. Kidneys may become abnormal with white urate deposits if the bird gets
dehydrated.

Soft tissues other than synovium are rarely involved. However, comb, wattles, and trachea have been
observed to be involved.

Granulomatous inflammation in synovium and other tissues.

NEPHROSIS

nephrosis is a non-specific primary degenerative affection of the kidney without a significant

inflammatory component. The kidneys are often uniformly pale, but a satisfactory and reliable diagnosis
cannot be made merely by gross examination. A large number of poisons, from simple inorganic to
complex organic ones, can cause nephrosis; If this tubular damage is sufficiently severe the birds may
die from renal failure which, in the less acute cases, is often accompanied by visceral gout.
Most primary inflammatory conditions of the kidney also show a degree of the degenerative tubular
change but this does not justify the use of the term nephrosis.