This report describes the case of a 53-year-old woman with chronic kidney disease (CKD) exacerbated by a gout flare who presented with renal tubular acidosis (RTA), hypokalemia, and hyperuricemia. Despite outpatient management for gouty nephropathy, the patient experienced progressive hypokalemia, leading to hospitalization. Upon admission, she was diagnosed with type 1 RTA, characterized by metabolic acidosis and severe hypokalemia, refractory to initial potassium supplementation. The patient's medical history included gout, chronic renal failure, and other comorbidities, complicating her condition. Treatment included aggressive potassium replacement and ongoing management of her gout and CKD. Over several hospital days, her potassium levels stabilized, and she was discharged on oral potassium supplements. This case emphasizes the importance of monitoring electrolyte imbalances and managing uric acid levels in patients with chronic gout and kidney disease to prevent complications such as RTA. Comprehensive management strategies, including dietary and pharmacological interventions, are critical to prevent the progression of gouty nephropathy and improve patient outcomes.
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