Stamp Lisa K, Chapman Peter T, Palmer Suetonia C
Department of Medicine, University of Otago, P.O. Box 4345, Christchurch 8140, New Zealand; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
Joint Bone Spine. 2016 Jan;83(1):19-24. doi: 10.1016/j.jbspin.2015.03.013. Epub 2015 Oct 6.
Allopurinol is the most commonly used urate lowering therapy in the management of gout. Despite the fact that it has been available for over 40 years there is ongoing debate about optimal allopurinol dosing in gout patients with chronic kidney disease. Given that gout is common in patients with renal impairment, clinicians need to be aware of the relationships between serum urate and kidney function as well as the effects of allopurinol on kidney function and vice versa. The use of allopurinol in patients on dialysis is an understudied area. Dialysis reduces plasma oxypurinol concentrations, therefore the dose and time of administration in relationship to dialysis need to be carefully considered. Recently, it has been suggested that there may be a role for allopurinol in patients with chronic kidney disease without gout. Observational studies have reported an association between serum urate and chronic kidney disease and end stage renal failure. The effect of urate lowering therapy with allopurinol on progression of kidney disease has been examined in small studies with varying results. Larger clinical trials are currently underway. This review will examine the relationships between allopurinol and kidney function in adults with and without renal disease and address allopurinol dosing in gout patients with impaired kidney function.
别嘌醇是痛风治疗中最常用的降尿酸药物。尽管它已上市40多年，但对于慢性肾脏病痛风患者的最佳别嘌醇剂量仍存在争议。鉴于痛风在肾功能损害患者中很常见，临床医生需要了解血清尿酸与肾功能之间的关系，以及别嘌醇对肾功能的影响，反之亦然。别嘌醇在透析患者中的应用是一个研究较少的领域。透析会降低血浆氧嘌呤醇浓度，因此需要仔细考虑与透析相关的给药剂量和时间。最近，有人提出别嘌醇在无痛风的慢性肾脏病患者中可能有作用。观察性研究报告了血清尿酸与慢性肾脏病及终末期肾衰竭之间的关联。在一些小型研究中已对别嘌醇降尿酸治疗对肾病进展的影响进行了研究，但结果各异。目前正在进行更大规模的临床试验。本综述将探讨别嘌醇与有或无肾脏疾病的成年人肾功能之间的关系，并讨论肾功能受损的痛风患者的别嘌醇给药问题。
