In line with the national think kidneys acute kidney injury programme, led by NHS England, the Acute Kidney Injury (AKI) alert system is being rolled out to cover patients in the community.
Reference range – male: 200 – 430 Micromol/L
Reference range – female: 140 – 360 Micromol/L
In recurrent clinical gout increase allopurinol to a target serum urate of <360 umoL or 300umol for persistent flares or in tophaceous gout.
See NICE gout guidelines.
Treatment with Allopurinol is first line and should be started at 100mg per day and titrated up based on serum urate levels (steady state reached at 4 weeks).
The usual dose needed is 300mg but doses up to 900mg/day may be needed (dose over 300mg should be given in divided doses)
Consider prophylaxis with colchicine 500mcg od-bd for up to 2-3 months while instituting Allopurinol therapy unless contraindicated.
Allopurinol dose in renal impairment. GFR ml/min (The Renal Drug Handbook 5th edition ).
GFR ml/min: 20-50 Allopurinol 200-300mg/day
10-20 Allopurinol 100-200mg/day
<10 Allopurinol 50 -100mg/day 100mg alternate days
Colchicine dose adjustment in renal impairment. GFR ml/min (The Renal Drug Handbook 5th edition/Renal Drug Database accessed Sept 2022):
GFR ml/min: 20-50: Reduce dose to 500mcg od.
10-20: Reduce dose to 500mcg once a day
<10: seek rheumatology/renal advice
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