Uric Acid Nephropathy Medication

  • Author: Mark T Fahlen, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Sep 21, 2011
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Xanthine oxidase inhibitors

Class Summary

Allopurinol is used for the prevention of acute uric acid nephropathy. By blocking the conversion of hypoxanthine and xanthine to uric acid, it produces a reduction in serum uric acid concentration and in the urinary excretion of urates. Allopurinol is used in the treatment of gouty arthritis.[10, 15, 16] Febuxostat may be considered for patients with allopurinol allergy or for those with renal impairment.

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Allopurinol (Zyloprim)

 

Inhibits xanthine oxidase, the enzyme that synthesizes uric acid from hypoxanthine. Reduces synthesis of uric acid without disrupting biosynthesis of vital purines.

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Febuxostat (Uloric)

 

Xanthine oxidase inhibitor. Prevents uric acid production and lowers elevated serum uric acid levels. May be considered as an alternative to allopurinol. Febuxostat is extensively metabolized in the liver and excreted in the feces and urine, largely as metabolites. No dosage change is necessary unless severe renal or hepatic impairment exists.

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Contributor Information and Disclosures
Author

Mark T Fahlen, MD  Inc

Mark T Fahlen, MD is a member of the following medical societies: American College of Physicians and Renal Physicians Association

Disclosure: Nothing to disclose.

Coauthor(s)

Mahendra Agraharkar, MD, MBBS, FACP, FASN  Clinical Associate Professor of Medicine, Baylor College of Medicine; President and CEO, Space City Associates of Nephrology

Mahendra Agraharkar, MD, MBBS, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology, and National Kidney Foundation

Disclosure: South Shore DaVita Dialysis Center Ownership interest Other

Specialty Editor Board

Frank C Brosius III, MD  Nephrology Program Director, Professor of Internal Medicine and Physiology, Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine

Frank C Brosius III, MD is a member of the following medical societies: Alpha Omega Alpha, American Diabetes Association, American Society of Nephrology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eleanor Lederer, MD  Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa

Disclosure: Dept of Veterans Affairs Grant/research funds Research

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Renal Ventures Ownership interest Other

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

References

  1. Conger JD. Acute uric acid nephropathy. Med Clin North Am. Jul 1990;74(4):859-71. [Medline].

  2. Guest SS. Uric acid and the kidney. In: Nephrology Rounds 4. Snell Medical Communications; 2001:1-5.

  3. Dykman D, Simon EE. Hyperuricemia and uric acid nephropathy. Arch Intern Med. Jul 1987;147(7):1341-5. [Medline].

  4. Nickeleit V, Mihatsch MJ. Uric acid nephropathy and end-stage renal disease--review of a non-disease. Nephrol Dial Transplant. Sep 1997;12(9):1832-8. [Medline]. [Full Text].

  5. Mene P, Punzo G. Uric acid: bystander or culprit in hypertension and progressive renal disease?. J Hypertens. Nov 2008;26(11):2085-92. [Medline].

  6. Avram Z, Krishnan E. Hyperuricaemia--where nephrology meets rheumatology. Rheumatology (Oxford). Jul 2008;47(7):960-4. [Medline].

  7. Iseki K, Ikemiya Y, Inoue T, et al. Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort. Am J Kidney Dis. Oct 2004;44(4):642-50. [Medline].

  8. Edwards NL. The role of hyperuricemia and gout in kidney and cardiovascular disease. Cleve Clin J Med. Jul 2008;75 Suppl 5:S13-6. [Medline]. [Full Text].

  9. Johnson RJ, Segal MS, Srinivas T, et al. Essential hypertension, progressive renal disease, and uric acid: a pathogenetic link?. J Am Soc Nephrol. Jul 2005;16(7):1909-19. [Medline]. [Full Text].

  10. Pea F. Pharmacology of drugs for hyperuricemia. Mechanisms, kinetics and interactions. Contrib Nephrol. 2005;147:35-46. [Medline].

  11. Lin JL, Yu CC, Lin-Tan DT, et al. Lead chelation therapy and urate excretion in patients with chronic renal diseases and gout. Kidney Int. Jul 2001;60(1):266-71. [Medline]. [Full Text].

  12. Bainbridge SA, Deng JS, Roberts JM. Increased xanthine oxidase in the skin of preeclamptic women. Reprod Sci. Feb 5 2009;[Medline].

  13. Mukherjee E, Mukherji D, Jayawardene SA, et al. Tumor lysis syndrome and acute renal failure--an increasing spectrum of presentations. Clin Nephrol. Sep 2007;68(3):186-9. [Medline].

  14. Fagugli RM, Gentile G, Ferrara G, et al. Acute renal and hepatic failure associated with allopurinol treatment. Clin Nephrol. Dec 2008;70(6):523-6. [Medline].

  15. Ueng S. Rasburicase (Elitek): a novel agent for tumor lysis syndrome. Proc (Bayl Univ Med Cent). Jul 2005;18(3):275-9. [Medline]. [Full Text].

  16. Hochberg J, Cairo MS. Rasburicase: future directions in tumor lysis management. Expert Opin Biol Ther. Oct 2008;8(10):1595-604. [Medline].

  17. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. Oct 23 2008;359(17):1811-21. [Medline].

 
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