Tophaceous gout results from continued precipitation of sodium urate crystals during attacks of acute gout. The sodium urate crystals incite a surrounding destructive inflammatory response. The pale areas seen here are aggregates of urate crystals surrounded by chronic inflammatory infiltrates of lymphocytes, macrophages, and foreign-body giant cells. Tophi are most likely to be found around joints, in soft tissue, including tendons and ligaments, and less commonly in visceral organs. Urate deposition also can occur in the kidney, and about 20% of patients with gout may eventually develop renal failure.