eMedicine Specialties > Pediatrics: General Medicine > Nephrology
Xanthinuria: Treatment & Medication
Updated: Jul 8, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Alkalinization of the urine has little effect on the solubility of xanthine.
- No specific therapies are available for classic xanthinuria; however, some general measures are recommended as follows:
- High fluid intake: A reasonable goal for fluid intake is 1.5-2 times maintenance spaced over 24 hours. Drinking water at night is important to prevent the usual development of a concentrated morning urine.
- Dehydration prevention: Educate the patient about the importance of preventing dehydration.
- Low-purine diet: Sources of food with lower purine content include cheese and eggs, grains, fruits, nuts, and most vegetables. The foods that contain higher amounts of purines are beef, pork, poultry, seafood, liver, kidney, and heart as well as peas, beans, spinach, and lentils.
- Xanthine dehydrogenase and aldehyde oxidase metabolize certain medications, and the enzyme-deficient or inhibited state can lead to toxic accumulation of the parent drug. Xanthine dehydrogenase is involved in degradation of azathioprine or 6-mercaptopurine, and aldehyde oxidase metabolizes allopurinol, cyclophosphamide, methotrexate, and quinine.
Surgical Care
- Xanthine stones are sensitive to extracorporeal shockwave lithotripsy. Consultation with a urologist is warranted because other techniques are available for stone removal.
Consultations
- Nephrologist
- Urologist
Diet
- Advise a low-purine diet (see Medical Care).
Activity
- Advise older patients with xanthine myopathy to avoid vigorous physical activity (eg, long-distance running).
Medication
No specific medication exists reduces xanthine production in the inherited forms of xanthinuria.
More on Xanthinuria |
| Overview: Xanthinuria |
| Differential Diagnoses & Workup: Xanthinuria |
Treatment & Medication: Xanthinuria |
| Follow-up: Xanthinuria |
| Multimedia: Xanthinuria |
| References |
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References
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].
Cameron JS, Moro F, Simmonds HA. Gout, uric acid and purine metabolism in paediatric nephrology. Pediatr Nephrol. Feb 1993;7(1):105-18. [Medline].
Carpenter TO, Lebowitz RL, Nelson D, Bauer S. Hereditary xanthinuria presenting in infancy with nephrolithiasis. J Pediatr. Aug 1986;109(2):307-9. [Medline].
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].
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].
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].
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].
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].
Simmonds HA, Reiter S, Nishino T. Hereditary xanthinuria. In: The Metabolic and Molecular Bases of Inherited Disease. 1995:1781-97.
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].
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.
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
Treatment & Medication: Xanthinuria