Acute gouty nephropathy is caused by precipitation of uric acid crystals in tubules, usually collecting ducts. Patients with acute gouty nephropathy present with severe hyperuricemia and acute oliguric or anuric kidney failure. This often occurs secondary to tumor lysis syndrome or crush injury. Uric acid calculi may occur in acute gouty nephropathy in 15%-20% of patients. Chronic gouty nephropathy is related to deposition of monosodium urate crystals primarily in the medulla and is usually seen in patients with gout, chronic hyperuricemia, and hypertension.