Acute uric acid nephropathy:
Under chemotherapy, patients should receive:
Treatment should be started as early as 1 - 2 days before the start of therapy.
Recommended dosage: 2 x 300 mg p. o. / d
It should be noted that the dosage of 6- mercaptopurine and azathioprine should be reduced by one third to one quarter when allopurinol is administered at the same time.
(Schmoll 2006)
- Alkalinisation of the urine
Alkalinization of the urine leads to better solubility of uric acid (Kuhlmann 2015).
This can be done medicinally by acetazolamide or i.v. administration of sodium bicarbonate. The target pH value should be between 7 - 8 (Schmoll 2006).
The drug was introduced in 2001 (trade name Fasturtec R ) and is - despite the lack of studies - recommended in first-line therapy (Kuhlmann 2015). It converts uric acid into the more soluble allantoin. Patients with the above risk factors (see "Etiology") and patients with a highly aggressive chemotherapy-sensitive tumor should be treated in parallel with rasburicase. The duration of therapy depends on the laboratory and clinical course (Schmoll 2006).
Dosage recommendation:
Rasburicase 0.15 mg to 0.2 mg / kg KG in 0.9% NaCl solution with a total volume of 50 ml 1 x / d i. v. (Schmoll 2006) or in combination with the above-mentioned hydrogenation i. v. (Kuhlmann 2015).
Chronic uric acid nephropathy:
Since uric acid crystallizes at acidic pH- values and returns to solution in an alkaline environment, this can be used therapeutically (Seitz 2018).
In order to raise the urine to a pH between 6.5 to 6.8 for metaphylaxis, alkali citrate or sodium bicarbonate can be used. The dose required for this varies greatly from individual to individual and should be determined by the patient himself by taking measurements several times a day.
The dissolution of uric acid stones is done medicinally with e.g. potassium citrate. The dosage must also be adjusted individually here, but until the pH value is alkalized to 7.0 - 7.2 (Seitz 2018).
Medicinal lowering of uric acid levels in the blood and / or urine by allopurinol. Recommended dosage: 100 mg - 300 mg / d (Seitz 2018).