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12:26 pm
April 29, 2009
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smurray12
Gouty Twinges
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This thread may be of interest to others. I'm 58 yrs old and fortunately don't suffer from gout in the conventional sense but I've recently experienced 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
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2:19 pm
April 29, 2009
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zip2play
Member
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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, probeneciid, that would INCREASE urinary excretion of uric acid. The main problem with probenecid is FORMATION of kidney stones.
Allopurinol, yes…probenecid NO!
What was you serum uric acid level?
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9:45 pm
April 29, 2009
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smurray12
Gouty Twinges
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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
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1:31 pm
May 1, 2009
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zip2play
Member
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Quote: Renal clearance of urate is significantly greater during P and A+P treatment compared to baseline and A alone.
smurray,
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, moreso even than allopurinol itself. Thus increasing it's 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 appproach urate kidney stones.
Your ultimate goal is a lifetime of urine with a very low concentration of urate.
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8:31 pm
May 2, 2009
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apcoach
Toe Torture (status changes after 50 posts)
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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-excretor is producing too much so the excretion would now be to the level of a normal person. How vulnerable to kidney stones is the averge, non-gout sufferer? High ph and Probenecid should prevent stones according to my doctor.
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