Uric Acid Kidney Stone: Will allopurinol help?

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This topic contains 12 replies, has 4 voices, and was last updated by  apcoach 1 week, 2 days ago.

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  • #3810

    Ahmed Abughrara
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    Hello

    2 years ago I have been diagnosed with a Uric Acid type kidney stone. Then the doctor asked me to take 300mg Dosage of Allopurinol. Because my uric acid went above 10.

    After 1 year I have been diagnostic again with a uric acid kidney stone. Even though I’m still taking this medicine.

    So, I had to have another surgery to remove them. And in both cases, I didn’t have any gout attack. Also in both cases, after taking the medicine the uric acid stays between 3.9-4.4

    Later I went to check this issue in Germany. But the doctor there told me to substitute the medicine with another one called Aden uric ( febuxostat ) 80mg. Because as he said it’s better than allopurinol.

    Adenuric 40mg (febuxostat)

    Is Adenuric 40mg (febuxostat) available in UK?

    Allopurinol or Adenuric?

    I start taking the medicine from 8 months now, no signs of any kidney stone. But I had another 2 problems which are:
    1- the uric acid levels are going below the normal range (below 3.5 ) if I continue to take the medicine for 1 month. So normally I will have to stop it for 1 week, wait for the uric acid level to go high ( 8 ). Then start taking this medicine again.
    2- in the last 2 months I started feeling that there is a sudden pain in my foot big toe. It comes suddenly and it feels like someone is scratching your finger with thorns. Then, it just stays for 1 min and goes. Usually, it happens every 3 days or so, sometimes at the night when I’m sleeping.

    the doctors in my country told me to go back to Allopurinol. But I’m afraid that it will make the stone come back again.

    what is your advice?
    And why do I start having this gout-like pain when the uric acid level is low?
    Also is it safe to split the Adenuric 80mg in half to take half the dosage? Or maybe take the medicine every 2 days instead of daily?

    Thanks

  • #1507

    Srini

    Merged from:

    Query regarding my gout symptoms

    Earlier I had two attacks of GOUT 2 years back and ~ 4 years back affecting severe pain in my ankle, toes which lasted for 3-4 weeks. I did not take any medicine and symptoms went away. my uric acid level was ~7

    But this time, it started with my left shoulder and spinal chord one upper joint and lightly on low back spinal chord, this time I measured my uric acid and it was 7.5. it was too severe pain for one month and then shifted to right shoulder.. then I started taking allopurinol 100mg per day, my upper back was hurting for a longer time and could not lift my hands up when it was too severe.

    after 1.5 months, it shifted to my mid and left hip, pain was not too severe, but was facing stiffness and burning pain if I sit for little long time and had to get up slowly to stretch before walking..

    by end of 1 month after taking Zyloric 1 per day, it’s reduced to 6.2, and after one and half month it’s reduced to 5.6

    after ~ 2 months, the attack started on my knees and foot including big toes and in between the fingers root of the foot. pain was unbearable and poking pain was lasting for 16- 24 hours and moving to new place, like this it was moving all over my knee one place at a time and moving down to feet and later it covered both the knees … the pain was too severe and dominant one place at a time…

    once my uric acid reached 5.6, the severity poking pain reduced and still was poking …

    later I took Zyclothicine 0.5 mg per day, after 6-7 days pain reduced drastically (70% down), but still it was hurting some new place, or old place with less intensity…

    now my uric acid < 5, and just taking one allopurinol 100 mg per day…

    my Rheumatologist, not believing it as gout, he asked me to take steroid 120 mg last Monday, now pain reduced to ~98 % , he ordered few tests like AntiCCP and HLAB27 both came -ve
    before taking steroid, my right shoulder started paining again a bit.

    now because of steroid, I am feeling =better in terms of pain , but feeling weaker now.
    my Rheumatologist, still could not come to any conclusion with the above reports and still in dilemma.
    I am a Male 44 years, with good health otherwise… confused all these problems because of URIC ACiD and some other issue? Request your help here… thanks: Srinivasa

    [Posted to GoutPal Helpdesk from What Are Your Signs Of Gout?]

    • #1513

      Srini

      Please note that I have kidney hydronephrosys with one kidney bulky and other one shrunken but both contributing 100% fliteration with 75 + 25

      my S.creatine is ~1.2 since 10 years
      BUN is in normal range

      I am not sure taking allopurinol 100 mg per day will have any impact on my kidney health..I drink lot of water and was exercising regularly before the current attack..

      My uric acid after reaching < 5 , now I reduced Zyloric 100mg one per day, before this I took 200mg per day for ~ 15 days when the level was 5.6 My dilemma is current attack is because of uric acid or some thing else... after the uric acid level reduced to 5, I was feeling 70% better than earlier, but it was continue to poke with small poking pain but was making internal injury, last was repeated on my right shoulder just before taking pro Medrol 120 mg as per my rheumatologist advice and he is also confused and doubting whether any other issue? I may need to wait for some more time as now my inflammation , pains are reduced except weakness. Looking for your kind advise further... Thanks Srinivas

    • #1546

      Srini


      Further update, now it is more than a week after taking depo Medrol 120 mg injection. no major pains , swelling or inflammation observed. But some times feels very light muscle pains in hands but comes and goes. started excercising, even though the knees are not quiet stable, but walked for ~ 2.5 to 3kms as part of it. Did station cycling for 10 mins.

      After reducing allopurinol from 200 mg to 100mg per day, uric acid again raised from 5.6 to 6 now
      my creatinine 1.12, eGFR 71

      still I am dieting and not taking much protein and lot reduced animal protein and took may be 50 grams chicken for whole week.

      Not willing to take further steroid… going to meet my phycian today, ASO test results yet to come.

    • #1549

      Keith Taylor
      Keymaster
      Ŧallars: Ŧ 870.15
      GoutPal Scholar Badge Rank: Scholar

      Thank you for lots of information. There is one important fact missing: when did you first start with gout symptoms?

      I’m guessing it was several years ago. So, you have to accept that it will take several months to dissolve old uric acid crystals. Until most of your old crystals dissolve, you are at risk of gout attacks. You need pain control for at least six months.

      Also, I strongly recommend increasing your allopurinol dose. Make sure your kidney function is OK. You seem to be OK with 200mg per day allopurinol. Take this, but go to your doctor after 2 weeks to get blood tests. You need uric acid, kidney function, and liver function tests.

      You should also consider further increases of allopurinol. This will shorten the period you are at risk from gout attacks. That is because lower uric acid levels cause old crystals to dissolve faster. Be very careful with this, as you have kidney problems. Increase dose gradually, and always get the 3 blood tests I mention – uric acid, kidney function, and liver function.

      You will find that gout attacks become less frequent and less painful. In a few months, when most uric acid crystals have dissolved, you will be free from gout pain.


      I think both cases in this topic are complicated. So, simple question and answer sessions are not best. Because a structured plan can help you understand uric acid effects on kidneys. Or, we can work out better therapies for your gout. Therefore, please consider starting a structured help plan:

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  • #3812

    nobody
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    The 80mg pill is designed to be split in half. No problem there and splitting ought to protect you better than taking one full pill every two days or to stop it for a week. But after diminishing your dose you would need to monitor your uric acid to see if it creeps back up above your target.
    You could also go back to allopurinol, but take more than 300mg this time. There are people here who take more than 300mg every day. The distributors of febuxostat (Adenuric) in Europe and the USA would have doctors believe that their product is stronger than allopurinol but actually it is only stronger than 300mg, not stronger than the maximum dose (unless you take even more than 80mg). Again, you would need to monitor your uric acid after switching back to allopurinol.

    Below 3.5 is in my opinion too low (except possibly for a few months to help with the dissolution of crystals) and you ought to cut the pill.
    It could be that what you are feeling in your foot are uric acid crystals dissolving. Temporary discomfort aside, that would be in my opinion healthy in the long run and you ought to consider not allowing your uric acid to climb above 5 for a while assuming that your liver is toleraring the strong dose your are taking (your livers markers are being monitored, right?).

    Don’t take my word for it but I seem to recall that diet can also affect your risk of forming uric acid stones.

    • This reply was modified 6 months, 2 weeks ago by  nobody. Reason: you have answered my question in your edit
  • #3814

    Ahmed Abughrara
    Participant
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    GoutPal Carer Badge Rank: Carer

    thanks for fast reply

    when i was taking the 300ml allopurinol , uric acid levels were stable between 3.9 and 4.4 depending on my diet

    for allopurinol300 and adenuric 80 , if i stop taking the dosage for 1 week the uric acid will elevate back to 8 or 8.5 directly

    i’m only doing kidney function tests regularly along with electrolyte ( potassium, sodium ,chloride ) ( and they are ok ) because no doctor told me to do liver test ( which tests should i do? , in the last 3 months i did the cholestrol( normal ) and electrolyttes ( slightly above normal ( 200 of 150 ))

    i dont have high blood pressure or diabetes , my length is 186cm , wight 95 kg but i have large bones so my wight is acceptable

    in general how can i know the root cause of why my uric acid is high? is it a medicine i took that triggered maybe something in the liver or is it my kidney is failing or another reason ?

    and last question , can adenuric or allopurinol couse any kidney or liver failure in the long run ( lets say i will take the medicine for the rest of my life and now i’m 34 Yrs )?

  • #3815

    nobody
    Participant
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    GoutPal Scholar Badge Rank: Scholar

    Yes, these drugs can damage your liver but they don’t do that to everybody. I don’t know about the kidneys (so far as I know, mine are healthy) but it sounds like your kidneys are being properly monitored anyway.
    See here for general information about liver tests: https://en.wikipedia.org/wiki/Liver_function_tests Maybe you are already being tested regularly but you didn’t realize it. The most basic tests are GGT, AST and ALT. Febuxostat is known to increase ALT in particular.

    There are many causes for high uric acid.
    There are tests you can do such as measuring the total amount of uric acid in your urine which could help with determining why your uric acid is high. It could indeed be a problem with your kidneys which have trouble getting rid of the stuff but your body could also simply produce way too much uric acid when you’re not taking medication.

    It sounds like 300mg allopurinol would be sufficient for you in the long run but one problem is that you may still have uric acid crystals in some parts of your body. Blood tests do not detect them and they can cause your uric acid to spike back up in between tests and possibly lead to kidney stones in spite of your low uric acid tests. These crystals should go away slowly if you keep taking medication and might be a reason to keep your uric acid unusually low for a while.
    So considering you had a stone in spite of 300mg allopurinol (have I got that right?), maybe 40mg febuxostat would be a bit too low. If you can get the 120mg pill, perhaps you could split it in half to get 60mg for a while and then try switching to 40mg later. You could also try to get around 60mg (precision is not important) from 80mg pills with a pill cutter or other tool. Allopurinol is easier to fine tune because there are 100mg pills everywhere while many countries do not have low-dose febuxostat pills.
    Exercise, doing drugs such as alcohol during the weekend and many other random variations in your diet and lifestyle could also raise your uric acid in between tests and possibly contribute to the formation of stones. Having very low uric acid test results would provide a buffer against all sorts of changes.
    To be clear: I’m no doctor and have had no kidney stones. I’m only making guesses here based on my experience with these drugs, what I’ve been told by my doctors and so forth. I can’t provide you a medical opinion on what your uric acid target should be.

  • #6034

    smurray12

    Combined Allopurinol and Probenecid therapy for treatment of Uric acid kidney stones

    I’m 58 yrs old and fortunately don’t suffer from gout in the conventional sense but I’ve recently experienced the onset of uric acid kidney stones. Fortunately, they’ve been quite small and perfectly spherical (1-2mm) and are passed painlessly. To eliminate their production my doctor has placed me on a treatment regime of 100mg once daily of Allopurinol combined with 250mg twice daily of Probenecid for 1 week and then increased to 500mg twice daily for the 2nd week.

    I’d be interested if others with this condition who have received this treatment might like to comment.

    Steve

    • #6035

      zip2play

      I’ve had only a tiny possible stone detected on an ultrasound but that was most likely spurious so I have no direct experience.

      I must wonder why your doctor put you on a drug, probenecid, that would INCREASE urinary excretion of uric acid. The main problem with probenecid is FORMATION of kidney stones.

      Allopurinol, yes…probenecid NO!

      What was your serum uric acid level?

    • #6036

      smurray12

      Not sure what the measure was but I’m advised it was high but not alarmingly so.

      Yes, I also queried the A+P aspect of the therapy. The chemistry is interesting. My doctor advised that the co-administration of A and P substantially boosts the clearance of oxypurinol and plasma urate concentrations generally decrease significantly. Renal clearance of urate is significantly greater during P and A+P treatment compared to baseline and A alone.

      I was advised that a really important part of this treatment is to drink at least 2 litres of water per day to avoid the formation of stones although I was advised by a doctor in the USA last year that increasing fluid intake by drinking more water does not in itself always result in eliminating the production of uric acid stones.

      This therapy will continue for two weeks when my uric acid level will be assessed and a further treatment regime determined.

      Steve

    • #6037

      zip2play

      Quote: Renal clearance of urate is significantly greater during P and A+P treatment compared to baseline and A alone.

      Steve,

      That’s exactly what I see as the problem here. Any increase in renal clearance will INCREASE your risk of stone formation rather than decrease it. What Allopurinol will do is allow you to produce LESS uric acid to CLEAR! Also, oxypurinol is the first metabolite of allopurinol and a potent xanthine oxidase inhibitor in its own right, more so even than allopurinol itself. Thus increasing its elimination will permit the formation of MORE uric acid from purine rather than less. Allopurinol plus copious amounts of water and urine alkalyzers is the way you want to approach urate kidney stones.

      Your ultimate goal is a lifetime of urine with a very low concentration of urate.

  • #6038

    apcoach

    I’m going to preface this reply by admitting that I don’t know very much about the science involved in this. However, the use of Probenecid to increase urate excretion makes a gout sufferer more like normal people whose uric acid is excreted before it becomes a problem for the joints. It is not that the under-excreter is producing too much so the excretion would now be to the level of a normal person.

    How vulnerable to kidney stones is the average, non-gout sufferer? High pH and Probenecid should prevent stones according to my doctor.

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