A 60-year-old male with chronic kidney disease (eGFR 25 mL/min/1.73m²) presents with acute onset severe pain, swelling, and redness in his left great toe. He was diagnosed with gout years ago. Which of the following is the most appropriate initial treatment for this acute flare?

✓ Correct Answer: Option D

In patients with renal insufficiency, NSAIDs are relatively contraindicated due to nephrotoxicity. Colchicine often requires dose reduction and monitoring due to increased toxicity. Allopurinol is for chronic prophylaxis, not acute flares. Oral corticosteroids are the preferred initial treatment for acute gout flares with significant renal impairment.