Allopurinol and renal impairment; as review on current findings

Abstract

Hyperuricemia is described as a serum uric acid level more than 6.0 mg/dL. It is demonstrated by basic research and clinical studies, which the elevation of uric acid level may change the renal histology and function by developing acute and chronic kidney diseases (CKDs), diabetic nephropathy and end-stage renal disease (ESRD). There is no doubt about a significant relationship between uric acid and renal impairment. However, the details of this correlation, especially; between uric acid and renal failure, are discussable. Renal vasoconstriction, antiangiogenic properties, endothelial dysfunction, proinflammatory properties, renal fibrosis, pro-oxidative properties, and alteration of renal autoregulation are the most common mechanisms, which approve the association between uric acid and renal impairment. Allopurinol administration for CKD treatment in patients with gout is one of the most discussable challenges. It should be investigated whether allopurinol can diminish the deterioration of the glomerular filtration rate (GFR) in CKD patients who are at risk of ESRD. Some previous studies reported that allopurinol decreases the CKD incident risk, but others could not confirm this association. The benefit or risks of allopurinol in different stages of CKD, dialysis, and renal transplant are discussed in this study.