Abstract
Despite widespread use, side effects of allopurinol have been rare. Problems arising in chronic renal failure (CRF) have been well documented,but necessity to reduce dosage in such cases is often ignored. Not so well known is the acute sensitivity to xanthine oxidase inhibition in situations of gross purine overproduction and the attendant risk of xanthine stones, or acute renal failure (ARF) from xanthine nephropathy.
To underline potential hazards and their avoidance, purine levels found in collaborative studies on allopurinol-treated patients are reported. 90% of referrals involved monitoring of plasma oxipurinol levels in CRF. Results frequently exceeded the desirable level of 100μmol/l, with values as high as 310μmol/l in those receiving 300mg/day and still 60μmol/l three days after stopping therapy in one case complicated by exfoliative dermatitis. One death from bone marrow aplasia had occurred prior to general awareness of the marrow depressant effects of sustained oxipurinol levels in CRF.
Four cases of ARF due to xanthine nephropathy occurred during therapy for conditions resulting in rapid cell lysis where plasma xanthine (normally <1μmol/1) and oxipurinol levels of 650μmol/l and 642μmol/l,respectively,were recorded. Two Lesch-Nyhan patients developed xanthine stones and required careful monitoring.The results demonstrate the effects of allopurinol overdose which should be avoidable through knowledge of purine metabolism in the particular situation.
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cameron, J., Simmonds, H. & Morris, G. THE USE AND ABUSE OF ALLOPURINOL IN RENAL FAILURE THE TUMOUR LYSIS SYNDROME AND UROLITHIASIS: 24. Pediatr Res 19, 747 (1985). https://doi.org/10.1203/00006450-198507000-00044
Issue date:
DOI: https://doi.org/10.1203/00006450-198507000-00044
