Role of hyperuricaemia in critically ill patients especially newborns

The results of animal experiments and clinical observations concerning the pathological role of hyperuricaemia and the effect of allopurinol treatment in acute metabolic disturbances and critically ill patients is reported. In uricase enzyme blocked rats treated by oxonic acid, urate nephropathy could be elicited by endogenous purine catabolism in shock. Hyperuricaemia aggravated the shock, while allopurinol increased the survival time. In shock resistant rats hyperuricaemia did not develop when shock was elicited. Allopurinol prevented hyperuricaemia and increased the physical performance of swimming rats, while in experimental DIC allopurinol reduced markedly the hyperuricaemia and the kidney damage. In clinical studies a close correlation was observed between the degree of hyperuricaemia and the severity of illness. Serum uric acid values were lowered in cases treated by peritoneal dialysis. In randomized control studies of newborns with IRDS the survival rate was improved by allopurinol treatment. In critically ill patients with various illnesses allopurinol prevented the progression of the pathological process and improved the clinical condition. The effect of allopurinol in acute clinical metabolic disturbances may be due to its protection against the renal damage by hyperuricaemia and against purine loss by inhibition of xanthine oxidase during the hypoxic stress and the enhancement of hypoxanthine salvage by HGPRT. Allopurinol reduced the production of superoxide radicals and thus the effect of injury may also be moderated by xanthine oxidase blockade.