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№2' 2016
NEPHROLOGYInternational Medical Journal, Vol. 22., Iss. 2, 2016, P. 47−53.
BASIC APPROACHES TO PHARMACOTHERAPY FOR GOUT NEPHROPATHY
N. A. Lopatkin Institute of Urology and Interventional Radiology Ministry of Health of Russia, Moscow, Russian Federation
Hospital № 57, Department of Health, Moscow, Russian Federation
Main clinical variants of kidneys impairment against a background of purine exchange disorders: acute urate (gout) nephropathy, urate tubular−interstitial nephritis, urate nephrolithiasis as well as the details of medication, used in modern nephrology for therapy of such diseases are described in this article. Basic medication for treatment of gout nephropathy is Allopurinol, highly effective in urate tubular−interstitial nephritis, acute uric acid nephropathy, urate nephrolithiasis in combination with hyperuricemia, and is the medication of choice for prevention of acute uric acid nephropathy development in cancer patients. Allopurinol frequently causes side effects, such as dyspepsia and dermatitis, that limit its usage. Alternative inhibitors of xanthy−oxidase is Febuxostat, that has a more favorable profile of safety. Uricosuric medications are rarely used at present due to their hepatotoxicity and high risk of recurrent urate nephrolithiasis. In cases of combination of gout and arterial hypertension in patients with preserved renal function and absence of nephrolithiasis, Losartan could be used, that is characterized by hypotensive and clinically meaningful uricosuric effect. Citrates are the drugs of choice for dissolution of renal calculi, consisting from uric acid and its derivates, and also for metaphylaxis of urate nephrolythiasis. Citrate therapy should be performed under a thorough urine pH control because its excessive alkalization could be followed by phosphate crystallization. Layering of phosphate film on the urate calculus makes ineffective the further treatment with citrate mixture.
Key words: gout nephropathy, urate nephrolithiasis, tubulointerstitial nephritis, xanthine oxidase inhibitors, citrate mixtures.