Q J Med 2002; 95: 597-607
© 2002 Association of Physicians
Early treatment with allopurinol in familial juvenile hyerpuricaemic nephropathy (FJHN) ameliorates the long-term progression of renal disease
From the 1 Purine Research Unit GKT, Departments of 2 Renal Medicine and 3 Paediatric Nephrology, Guy's Hospital, London, 4 Department of Paediatric Nephrology, Great Ormond Street Children's Hospital, London, 5 Middlesex Hospital, London, and 6 Renal Unit, St Mary's Hospital, Portsmouth, UK
Received 18 December 2001 and in revised form 2 May 2002
Background: The efficacy of allopurinol in autosomal dominant familial juvenile hyperuricaemic nephropathy (FJHN) has been disputed.
Aim: To address this question, in the absence of controlled trials.
Design: Retrospective long-term follow-up study.
Methods: All kindreds were biochemically screened. Measurements included uric acid clearance, creatinine clearance, serum creatinine, and glomerular filtration rate (GFR). We used five siblings who had died or progressed to transplantation, ten other deceased relatives, and two index cases (one untreated, one non-compliant) as controls to assess the effects of allopurinol.
Results: Of eight families with FJHN, six had a strong history of renal disease and early parental death (mean age 41 years, n=10). Of 27 patients started immediately on allopurinol and treated uninterruptedly, 21 responded well, including three children born subsequently. Eight siblings (mean age 19 years) with a normal plasma creatinine at start (<120 µmol/l, mean GFR 80 ml/min/1.73 m2) retained stable renal function (mean 14.5 years, mean age 34 years, GFR 85 ml/min/1.73 m2). Of the 13 other responders, treated for up to 34 years, 10 with a creatinine <200 µmol/l at diagnosis (mean age 28 years, mean creatinine 137 µmol/l at start) now have a mean creatinine of 210 µmol/l. In contrast, five patients (mean age 26 years) with a creatinine >200 µmol/l (GFR <35 ml/min/1.73 m2) when allopurinol commenced, plus one untreated index case, all progressed rapidly (mean 6 years) to end-stage renal failure. In two others (one non-compliant, one initially untreated), GFR fell by >50% in 7 years. Introduction of allopurinol in the latter has stabilized GFR.
Discussion: Allopurinol reduced the morbidity and mortality from renal failure seen in untreated siblings and previous generations of these families. Early diagnosis of FJHN is important, so that treatment can begin before irreversible renal damage has developed.
Address correspondence to Dr D.J.A. Goldsmith, 4th Floor TGH, Guy's Hospital, London Bridge SE1 9RT. e-mail: david.goldsmith{at}gstt.sthames.nhs.uk
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