26th June 2023

A 49-year-old male presents with a few months’ history of nocturia and a very painful right big toe.

A 49-year-old male presents with a few months’ history of nocturia and a very painful right big toe. He has had this pain before and was previously on allopurinol for a few months but stopped it some time ago because he didn’t think it was working. He has also previously been given colchicine for the pain. He admits he has a poor diet and drinks 27 units of alcohol a week.

The GP performs a urine dipstick and basic observations:

Urinalysis: proteinuria 1+, leukocytes positive, nitrites negative, blood negative

Urine culture: No growth

Observations: RR 12, HR 85, BP 125/80, O₂ saturations 98% on air, Temperature 37.2

What is the most likely cause of the patient’s new nocturia?

Select the SINGLE most appropriate option from the list below. Select ONE option only.