Current Possibilities in the Correction of Hyperuricemia in Patients with Urolithiasis and Uric Acid Hypercrystallization

Abstract

The objective: to study the effectiveness of the reception and the peculiarities of the use of the drug febuxostat in the correction of the level of uric acid (UA) in the blood serum of patients with urolithiasis and uric acid (UA) hypercrystalluria compared with allopurinol.Materials and methods. The study involved 310 patients with urolithiasis and UAH in whom hyperuricemia was detected. Patients of the 1st group (n = 124) took febuxostat, the 2nd group (n = 186) took allopurinol. Monitoring the level of UA in blood serum and urine was performed 1 time per month for the first 3 months and 1 time in 2 months for the next 10 months.Results. Depending on the speed of reaching the target level of serum UA in the course of treatment with both drugs, three groups were identified: a – 106 (36.3%) patients with fast achievement of the target level of UA in serum (in the first 2 months); b – 100 (35.2%) patients with a significant decrease in uricemia in the first 2 months and a long time to reach the target UA values in blood serum (more than 4 months); s – 86 (29.3%) patients with severe correction of hyperuricemia (more than 6 months). The use of febuxostat makes it possible to achieve the target serum UA level faster and safer than allopurinol – after 4 months in 102 (82.3%) patients of the 1-st group compared with 61 (36.2%) patients of the 2nd group. The absolute values of the level of UA in plasma are not decisive in the choice of the initial dose of febuxostat. The criterion for the safe transfer of patients to maintenance doses of uricostatic drugs is the normalization of UA levels not only in blood serum, but also in urine. The use of febuxostat and allopurinol preparations requires an individual selection of therapeutic and maintenance doses, based on dynamic control of the level of UA in the blood serum and urine during treatment for a long period of time. A significant increase in the level of daily diuresis while taking both uricostatic drugs may indicate an improvement in renal function and also the possibility of restoring the functional state of the tubular apparatus against the background of an adequate correction of hyperuricemia, the possibility of reverse changes caused by urate nephropathy is more pronounced while taking febuxostat.Conclusion. Febuxostat is a modern powerful uricostatic drug with a selective mechanism of action and better efficacy (93.5% in the 1st group compared to 78.1% of the patients in the 2nd group), as well as tolerance than allopurinol (side effects in 9, 6% of patients). The inclusion of febuxostat in the complex of measures for prophylactic and metaphylaxis of urolithiasis for faster and safer correction of hyperuricemia will make it possible to increase their effectiveness.