In this article the main clinical scenarios of the purine metabolism (PM) disorders, which could be the case in urological practice, are described. Also a reference to the pathogenesis is given shortly.
PM is a complicated biochemical process including many enzyme systems. Uric acid is being synthetized predominately during the process of the nucleic acids metabolism, but the other ways are also to be considered. The top important mediator is inosine acid, which is further hydrolyzed. The resulting hypoxanthine is a source of the xanthine and uric acid. From the biochemical point of view PM disturbances are the various types of the disbalance within the enzyme systems in charge of the synthesis and transportation of the uric acid and it’s precursors.
We make a point at the different clinical variants of the podagric nephropathy, especially at the pathogenesis details and clinical signs. The pathophysiology of the podagric tubulointerstitial nephritis and acute uric nephropathy is described. Main approaches to the treatment of the patients with theses conditions are discussed with a special accent on citrate therapy. Specific medications in this case are allopurinol and citrate mixtures. Allopurinol is indicated by tubulointerstitial nephritis, acute uric nephropathy, urate urolithiasis in coincidence with hyperuricemia and in case of the chemotherapy of the malignant tumors. The performance capabilities of citrate mixtures are shown as monotherapy and in the combination with other medications. The method of the dosage calculation for the citrate mixture is presented. The indications and contraindications to these medications are defined.
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