eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Xanthinuria: Follow-up

Author: Sahar Fathallah-Shaykh, MD, Assistant Professor in Pediatric Nephrology, Northwestern University Feinberg School of Medicine; Consulting Staff, Division of Kidney Diseases, Children's Memorial Hospital
Coauthor(s): Steven C Diven, MD, Medical Director of Pediatric Dialysis Unit, Assistant Professor, Department of Pediatrics, University of Texas Medical Branch at Galveston
Contributor Information and Disclosures

Updated: Jul 8, 2008

Follow-up

Further Inpatient Care

  • Inpatient care may be necessary for the secondary complications of pyelonephritis, obstructive urolithiasis, or acute renal failure.

Further Outpatient Care

  • Monitor frequency of symptoms, renal function, and passage of stones.
  • Ensure consistent high intake of fluid to maintain dilute urine.
  • Monitor purine intake.

Complications

  • Urolithiasis
  • Crystal nephropathy
  • Renal failure
  • Obstructive uropathy
  • Urinary tract infection
  • Hematuria
  • Myopathy
  • Arthropathy
  • Arthritis

Prognosis

  • Prognosis depends on the degree of renal injury from crystal nephropathy, urinary obstruction, and/or pyelonephritis.

Patient Education

Advise patients regarding the importance of the following:

  • Maintaining a dilute urine
  • Avoiding dehydration
  • Intervening early for conditions that may lead to dehydration
  • Avoiding high-purine foods
  • Providing proper home therapy for renal colic

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis in a patient with renal colic and evidence of a radiolucent stone

Special Concerns

  • Infants and young children may have nonspecific symptoms related to the urinary system, including persistent emesis, irritability, anorexia, poor weight gain, or hematuria.
  • Older patients are more likely than children to have muscle symptoms from xanthine and hypoxanthine tissue deposits.
 


More on Xanthinuria

Overview: Xanthinuria
Differential Diagnoses & Workup: Xanthinuria
Treatment & Medication: Xanthinuria
Follow-up: Xanthinuria
Multimedia: Xanthinuria
References

References

  1. Sikora P, Pijanowska M, Majewski M, Bienias B, Borzecka H, Zajczkowska M. Acute renal failure due to bilateral xanthine urolithiasis in a boy with Lesch-Nyhan syndrome. Pediatr Nephrol. Jul 2006;21(7):1045-7. [Medline].

  2. Cameron JS, Moro F, Simmonds HA. Gout, uric acid and purine metabolism in paediatric nephrology. Pediatr Nephrol. Feb 1993;7(1):105-18. [Medline].

  3. Carpenter TO, Lebowitz RL, Nelson D, Bauer S. Hereditary xanthinuria presenting in infancy with nephrolithiasis. J Pediatr. Aug 1986;109(2):307-9. [Medline].

  4. Fildes RD. Hereditary xanthinuria with severe urolithiasis occurring in infancy as renal tubular acidosis and hypercalciuria. J Pediatr. Aug 1989;115(2):277-80. [Medline].

  5. Gomez GA, Stutzman L, Chu TM. Xanthine nephropathy during chemotherapy in deficiency of hypoxanthine- guanine phosphoribosyltransferase. Arch Intern Med. Jun 1978;138(6):1017-9. [Medline].

  6. Leimkuhler S, Charcosset M, Latour P, et al. Ten novel mutations in the molybdenum cofactor genes MOCS1 and MOCS2 and in vitro characterization of a MOCS2 mutation that abolishes the binding ability of molybdopterin synthase. Hum Genet. 2005;117(6):565-70. [Medline].

  7. Macaya A, Brunso L, Fernandez-Castillo N, et al. Molybdenum cofactor deficiency presenting as neonatal hyperekplexia: a clinical, biochemical and genetic study. Neuropediatrics.Dec;. 2005;36(6):389-94. [Medline].

  8. Reiter S, Simmonds HA, Zollner N, et al. Demonstration of a combined deficiency of xanthine oxidase and aldehyde oxidase in xanthinuric patients not forming oxipurinol. Clin Chim Acta. Mar 15 1990;187(3):221-34. [Medline].

  9. Simmonds HA, Reiter S, Nishino T. Hereditary xanthinuria. In: The Metabolic and Molecular Bases of Inherited Disease. 1995:1781-97.

  10. Teksam O, Yurdakok M, Coskun T. Molybdenum cofactor deficiency presenting with severe metabolic acidosis and intracranial hemorrhage. J Child Neurol. 2005;20(2):155-7. [Medline].

  11. van Gennip AH, Mandel H, Stroomer LEM. Effects of allopurinol on the xanthinuria in a patient with molybdenum cofactor deficiency. In: Purine and Pyrimidine Metabolism in Man. Vol 8. 1995:375-8.

  12. Zannolli R, Micheli V, Mazzei MA, et al. Hereditary xanthinuria type II associated with mental delay, autism, cortical renal cysts, nephrocalcinosis, osteopenia, and hair and teeth defects. J Med Genet. Nov 2003;40(11):e121. [Medline].

Further Reading

Keywords

xanthinuria, classic xanthinuria, hereditary xanthinuria, iatrogenic xanthinuria, xanthuria, xanthiuria, xanthine in the urine, arthropathy, myopathy, crystal nephropathy, urolithiasis, renal failure, microcephaly, hyperreflexia, Lesch-Nyhan syndrome, xanthine nephropathy, acute kidney failure, hematuria, interstitial nephritis, chronic renal failure, end-stage renal disease, arthritis, arthralgia, renal colic, urinary tract infection, urolithiasis

Contributor Information and Disclosures

Author

Sahar Fathallah-Shaykh, MD, Assistant Professor in Pediatric Nephrology, Northwestern University Feinberg School of Medicine; Consulting Staff, Division of Kidney Diseases, Children's Memorial Hospital
Sahar Fathallah-Shaykh, MD is a member of the following medical societies: American Society of Nephrology
Disclosure: emedecine Honoraria Other

Coauthor(s)

Steven C Diven, MD, Medical Director of Pediatric Dialysis Unit, Assistant Professor, Department of Pediatrics, University of Texas Medical Branch at Galveston
Steven C Diven, MD is a member of the following medical societies: National Kidney Foundation
Disclosure: Nothing to disclose.

Medical Editor

Richard Neiberger, MD, PhD, Director of Pediatric Renal Stone Disease Clinic, Associate Professor, Department of Pediatrics, Division of Nephrology, University of Florida College of Medicine and Shands Hospital
Richard Neiberger, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Medical Association, American Society of Nephrology, American Society of Pediatric Nephrology, Christian Medical & Dental Society, Florida Medical Association, International Society for Peritoneal Dialysis, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Shock Society, Sigma Xi, Southern Medical Association, Southern Society for Pediatric Research, and Southwest Pediatric Nephrology Study Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Luther Travis, MD, William W Glauser Professor of Pediatrics and Pediatric Nephrology, Department of Pediatrics, Divisions of Nephrology and Diabetes, University of Texas Medical Branch and Children's Hospital
Luther Travis, MD is a member of the following medical societies: Alpha Omega Alpha, American Federation for Medical Research, International Society of Nephrology, and Texas Pediatric Society
Disclosure: Nothing to disclose.

CME Editor

Howard Trachtman, MD, Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine
Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD, The Isaac A Abt, MD, Professor of Kidney Diseases, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology
Disclosure: Amgen Grant/research funds None; Abbott Honoraria Speaking and teaching; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

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