A 32 year old male presented with the pain in the foot and finger. mild anemia and a mildly raised ESR present. His serum uric acid was 8.8 mg/dl and serum Creatinine was elevated at 1.99 mg/dl. His creatinine clearance was low at 50 ml/min/body surface area. Electrolytes were normal. Urine examination was normal. His blood sugar and hepatic profile were normal. What would you say about the radiographs.

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Hyperuricemia due to underlying chronic kidney disease. Clinically, Gouty presentation, which needs uricosuric drugs (Allopurinol/Febuxostat) in appropriate doses, coupled with medications for renal disease.

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