Comparative evaluation of uricodepressants allopurinol and febuxostat in gouty nephropathy. Message 1. Сlinical study
Background. Renal damage is an almost constant symptom of gout, which determines the prognosis of the disease. Hyperuricemia in gouty nephropathy belongs to independent risk factors for deterioration of the nitrogen and electrolyte excretory function of the kidneys. The purpose of the study was a comparative evaluation of the effect of uricodepressants allopurinol and febuxostat on the functional state of the kidneys in patients with gout. Materials and methods. Seventy three patients with primary gout (men with an average age of 49 years and disease duration of 10 years) were examined. The chronic form of arthritis was diagnosed in 71 % of cases, the intermittent one — in 29 %, peripheral tofi were detected in 53 % of patients. Chronic kidney disease stage I, II, III and IV was diagnosed at a ratio of 56 : 12 : 2 : 1, latent, urolytic and proteinuric types of gouty nephropathy — in 53, 37, 10 % of cases, arterial hypertension — in 47 %. Hyperuricemia at the time of examination was found in 84 % of patients, hyperuricuria — in 52 %, metabolic, renal and mixed types of hyperuricemia occurred in 57; 3 and 40 % of cases, respectively. Results. Comparative evaluation of allopurinol, a xanthine oxidase inhibitor, and febuxostat, a xanthine oxidoreductase inhibitor, in terms of kidney function in patients with gouty nephropathy, showed that the latter should be preferred, although the hypouricemic effect of both uricodepressants is approximately the same, and the initial indices of viscoelasticity of urine and β2-microglobulinuria are prognostic criteria for the efficacy of allopurinol and febuxostat therapy, respectively. Conclusions. In the future, it will be useful to determine the morphological changes in the kidneys in experimental gouty nephropathy under the influence of allopurinol and febuxostat, and it is also advisable to evaluate the results of combined use of uricodepressants with other groups of hypouricemic agents (uricosuric drugs, pegloticase enzyme, etc.).
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