Hi guys,
I have CKD and take 300 mg of allopurinol daily due to recurrent gout over the past 30 years. I'm interested in hearing from others who have been in a similar situation. Has anyone noticed any improvement in their kidney function after reducing their allopurinol dosage? Any insights would be greatly appreciated.
Allopurinol saved my kidneys from further damage from kidney stones. I had five very big ones and I pass over 30 over two years that were small or gravel. Gout is caused by uric acid build up which turn into crystals that cause inflammation and then pain. Lowering my uric acid levels also helped. Also learn what food trigger Gout. It has to do with purines.
Thanks Ive had a couple of stones myself - one was uric acid and the calcium. My doctor thought I could 'TRY' and see if reducing my allopurinol would help my EGFR come up but she wasn't very assuring and the last time I changed the dose I had a a flare up.
The caveat to your situation, something I've seen a few times, is too many conflate elevated blood uric acid levels with formation of stones. Stones are formed by 4 common mechanisms: high 'urine uric acid'(hold that thought), high urine oxalate(usually genetic or gastric bypass), high urine calcium(primary hyperparathyroidism, genetic, Sarcoidosis, too much calcium carbonate{Tums} intake, etc), or low urine Citrate (genetic, polycystic kidney disease, etc). Hypercysteinuria is very unique, genetic, and runs in few families, it is the 5th cause.
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Most high blood uric acid levels(Gout or hyperuricemia w/o Gout, each have their own ICD-10 code) are caused 80-90% or so, by 'underexcretion of uric acid', meaning it is not possible for high blood urate to cause stones as it is the effect of low 'urine' uric acid(back to high urine uric acid representing one of the 4 common stone formation risks above), therefore, someone may be inappropriately treated based on presumptions abut urine uric acid and blood uric acid.
Example: I recently saw someone with a uric acid stone 20+ years ago(rather eventful, needing procedures to extract), been on Allopurinol since, because the strained stone 20+ yrsa ago was a 'urate' stone(which is atypical in that 85% of all stones are Calcium oxalate, though CaOx stones can be caused by a urate nidus).
Long story short, he had extremely low urine citrate as his primary cause and is now on K citrate(with lemon juice as tolerated, however he can prepare it), both pouring more citrate through the urine which disallows uric acid and CaOx stones to form. More than likely, his low urine citrate then, caused his urate stone, not elevated urine urate.
Caveat: urate and uric acid are the same
Would recommend getting a second look
Of note there is about an 80% chance of not having another symptomatic stone every 10 years, regardless of cause hence 'not having noticeable stones' over years doesn't necessarily equate to being treated.
Please research(in verified medical sources everything written here which is true or very close to true)
Good luck!
Awesome information, thanks so much for your insights. very helpful.
Let me also state, there are 'zero' randomized, prospective studies showing Allopurinol benefit with renal disease(you are free to look).
Given an overwhelming majority of hyperuricemias are indeed 'under-excreters' of uric acid(please research that because it is true), it hardly makes sense, yet it is the dogma of enough Nephrologists that it helps kidney function. As to stabilization, truly look at your curve given Scr rises or falls in 0.2-0.3mg/dl 'zones if you will' - example your creatinine of 1.7 doesn't stay that way, not even from day to day, rather is more likely 1.6-1.9 with up and down variations based on the volume status that day(or if you took a couple of Advil, hopefully not). If you're meeting parameters like BP is controlled, DM controlled, and avoiding nephrotoxins, you can be stable for 10, 15, 20 years(assuming no other factors like IgA Nephropathy, FSGS, Lupus, etc - then it relies on specifically stabilizing these by whatever immunosuppression mechanism).
If your eGFR declines, your zone(or range) would change to something like 2.0-2.3mg/dl if you get the gist. The exception is latter stage Diabetic Kidney Disease which can fall off much faster at any time once in stage 4 or so, especially if glycemic control is not optimal.
My point is you'll find few people stating 'stabilization' w/ Allopurinol can truly note their range(or zone) stabilized with the start of Allopurinol. Does Allopurinol knock off Gout attacks? Absolutely! That's what is does best, then treating(slowly) tophi? Yes. Renal disease? I am truthful when I say not so much and unproven, but it does not hurt your kidneys either(with provisions).
Please look up the dosing range of Allopurinol for certain eGFRs(though this is a bit loose, I'll personally dose no more than 100mg beyond a stated eGFR range, not exceeding 200-300mg/day) Actual Allopurinol toxicities? (mild/moderate) rare liver toxicity and maybe mild bne marrow effects - lower WBC, Hemoglobin, etc{reversible upon discontinuation}. It does not affect your kidney function(so long as under 200-300mg/day). Try a pharmacology source(or sources) rather than word of mouth or reputation. The latter will lead you astray.
Best to you all!
I am taking Allopurinol due to high uric acid in my blood. It helps. My eGFR has stabilized.
could I please ask the dose you are on? 300? 150?
I take 200 mg and gout is stabilized. If I reduce this dose. I start to get tingling in my toes and almost have a flare-up. But, everyone is different. I believe dosage depends on your uric acid level.
Same comment as drmind. 200mg has kept all readings stable for over a year
200mg and stable for 18 months now. Had really bad flare ups of uric acid for 3 months before I got the right dose. My gout was due to my ckd.
Good to know thanks. In Australia I found out that you can only take 2 x 100 mg pills and not just 1 x200 mg pill.
same, I’m on 2 100mg pills but 200mg total.
Dear Ziggy
Allopurinol can reduce your levels of Uric Acid, which reduces the likelihood of gout. As to whether it improves eGFR, that is not certain. I have been taking allopurinol for gout and that has worked (no gour for a long time and last time I checked the Uric Acid it was in the normal range (highest ever was a bit over 13 if I recall correctly). My eGFR has remained stable, so whether the Allopurinol has affected that is uncertain in my case, but Allopurinol should positively affect your eGFR as well with steady use (ncbi.nlm.nih.gov/pmc/articl.... On a side note, after several years without any symptoms I recently got a descending kidney stone for the second time (as was the case the first time, several other stones have been detected in both kidneys), so I am staying well hydrated and drinking water with squeezed lemon nearly every day.
Hello, Allopurinol can damage your kidneys but gout must be controlled.
I was on 100mg per day but took advice from my excellent pharmacist. He advised me to take a lower dose (50mg) and see how it went, any sign of gout to return to full dose straight away. Worth a try I thought. Cut my pills in half and that was 2 years ago-no sign of gout, so my fingers are still crossed!
Ask your Neph or (good) Pharmacist.
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