APRT and hyperinsulinemic hypoglycemia, familial, 4: In patients with complete APRT deficiency, adenine is oxidized by xanthine oxidase (XO) to the highly insoluble and nephrotoxic derivative 2,8-dihydroxyadenine (2,8-DHA) [4], leading to urolithiasis and renal failure caused by intratubular crystalline precipitation [5,6].