The Effect of Hyperuricemia and Allopurinol Treatment Outcome of Greft in Kidney Transplant Recipients

Öz

Introduction: Kidney transplant recipients(KTRs) may have high level of serum uric acid(SUA) due to greft dysfunction and immunosuppressives. In this study, we evaluated effect of high SUA levels and allopurinol therapy in KTRs on renal functions. Patients and Methods: 113 of 233 KTRs had elevated SUA level(G1). Fiftyseven of G1 received allopurinol treatment(G1A+) and 56 patients G1A-) did not. 56 of 118 patients who were followed for five years(G5) were hyperuricemic(G5-1) and 26 of G5-1 treated with allopurinol(G5-1A+) and 30 of them did not(G5-1A-). 62 patients were normourisemic(G5-2). GFR<10 ml/min was considered as graft loss. Results: Of the 233 patients the mean age was 42.8±11.6(17-76), 164 were male(70.0%). In 2.year graft loss developed in 9(7.5 %) and 18(15.9%) of G2 and G1 respectively(p=0.045). According to allopurinol therapy 10 of the graft loss occurred in the G1A+ and 8 in the G1A-(p=0,330). Graft loss occurred in 12(21%) and 9(14%) in G5-1 and G5-2 respectively(p=0.62). Graft loss occurred in 7(23%) and 5(19%) in G5-1A+ and G5-1A- respectively(p=0.71). Considering the first two years graft loss in G5-1 was higher than in the G5-2(p=0.023), and higher SUA levels increased the graft loss by 3.6 times compared to normal SUA levels(95% confidence interval(1,2-12.70). Conclusion: There was a significant relationship between high SUA levels and graf loss in KTRs in 2 years and 5 years. Treatment of high SUA with alIopurinol therapy had protective effect on renal functions. So that tretment of hyperuricemia such as allopurinol can be good option to preserve kidney function in KTRs.

Anahtar Kelimeler

• : Uric acid
• renal dysfunction
• allopurinol
• kidney transplant recipient

Böbrek Nakil Hastalarında Hiperürisemi ve Allopuirnol Tedavisinin Graft Sonlanımına Etkileri

Öz

Giriş: Böbrek nakli alıcılarında; greft disfonksiyonu ve kullanılan immünsüpresifler nedeniyle serum ürik asit(SUA) seviyesi artabilir. Çalışmamızda, böbrek nakli alıcılarında yüksek SUA düzeyleri ve allopurinol tedavisinin böbrek fonksiyonları üzerindeki etkileri değerlendirildi. Hastalar ve Yöntemler: Çalışmaya alınan 233 böbrek nakli alıcılarından 113’ünde SUA düzeyi yüksek idi (G1). G1'de allopurinol tedavisini 57 hasta(G1A+) aldı ve 56 hasta(G1A-) almadı. Beş yıl takip edilen (G5) 118 hastanın 56'sında hiperürisemi (G5-1) saptandı. G5-1'de 26 hasta allopurinol (G5-1A+) ile tedavi edildi, 30 hastada allopurinol verilmemiş idi (G5-1A-). G5’de 62 hasta normourisemikti (G5-2). Glomerül filtrasyon hızı<10ml/dk greft kaybı olarak kabul edildi. Bulgular: 233 hastanın yaş ortalaması 42,8±11,6 (17-76), 164'ü erkekti (%70,0). 2.yılda G2 ve G1'de sırasıyla 9 (%7,5) ve 18 (%15,9) greft kaybı gelişti (p=0,045). Allopurinol tedavisine göre greft kaybının 10'u G1A+'da, 8'i G1A-'de meydana geldi (p=0,330). G5-1 ve G5-2'de sırasıyla 12 (%21) ve 9 (%14) greft kaybı meydana geldi (p= 0,62). G5-1A+ ve G5-1A-'da 7 (%23) ve 5'te (%19) greft kaybı meydana geldi (p = 0.71). İlk iki yıl dikkate alındığında, G5-1'deki greft kaybı G5-2'dekinden daha yüksekti (p = 0,023). Yüksek SUA seviyeleri, normal SUA seviyelerine göre greft kaybını 3,6 kat arttırdı (%95 güven aralığı:(1,2-12.70). Sonuç: Böbrek nakli alıcılarında 2. yıl ve 5. yılda yüksek SUA düzeyleri ile graf kaybı arasında anlamlı bir ilişki vardı. Yüksek SUA'nın allopurinol tedavisi ile böbrek fonksiyonlarını koruyucu etki göstermiştir. Bu nedenle, allopurinol gibi hiperürisemi tedavisi, böbrek nakli alıcılarında böbrek fonksiyonunu korumak için iyi bir seçenek olabilir.

Anahtar Kelimeler

• Ürik asit,
• böbrek nakli alıcısı
• böbrek fonksiyon bozukluğu
• allopurinol

Kaynakça

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