What to do about allopurinol in renal impairment? A question that has taxed clinicians  for many years. In a new study published in JAMA Internal Medicine, researchers have suggested that this drug may be less fraught for these patients than previously thought. People with newly diagnosed gout who started treatment with allopurinol (≥300 mg/d) were compared with those who did not . 4760 initiators of allopurinol were compared to the same number of non-initiators of allopurinol (excluding those with chronic kidney disease stage 3 or higher or urate-lowering therapy use before their gout diagnosis). The researchers found that allopurinol initiation was actually associated with a lower risk of renal function deterioration, meaning that clinicians should consider evaluating other potential causes when patients with gout experience renal function decline.