Avoiding dialysis in tumour lysis syndrome: is urate oxidase effective? - a case report and review of literature.

Abstract

INTRODUCTION:

Hyperuricaemia in tumour lysis syndrome (TLS) can cause acute renal failure (ARF), necessitating dialysis. Recombinant urate oxidase (rasburicase) converts uric acid to soluble allantoin, which is excreted easily.

CASE REPORT:

An 8-year-old boy with stage 3 Burkitt's lymphoma, TLS was successfully treated with hyper-hydration, diuretics and rasburicase, without dialysis. This is the first paediatric case in Kandang Kerbau Women's & Children's Hospital (KKH) in which rasburicase was used. We review the literature on the effectiveness of urate oxidase in avoiding dialysis in TLS.

TREATMENT AND OUTCOME:

Our patient developed rapidly rising serum uric acid (SUA) and progressive renal impairment. Hyper-hydration and rasburicase (0.2mg/kg) were administered. SUA rapidly decreased from 1308 to 437 mmol/L within 12 hours. Urate oxidase has shown better results than allopurinol. There was a need for dialysis in 0.4% to 1.7% of patients with haematological malignancies given rasburicase, compared to 20% in patients given allopurinol.

CONCLUSIONS:

Rasburicase can reverse renal insufficiency. Though expensive, it may be cost-effective by lowering incidence of dialysis, shortening the duration of intensive care and hospitalisation, allowing early chemotherapy.

• Authors: Wan Yee Teo, Tsee Foong Loh, Ah Moy Tan
• Journal: Annals of the Academy of Medicine, Singapore (Ann Acad Med Singap) Vol. 36 Issue 8 Pg. 679-83 (Aug 2007) ISSN: 0304-4602 [Print] Singapore
• PMID: 17767339 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Uric Acid
• Urate Oxidase

Topics

• Burkitt Lymphoma (complications)
• Child
• Humans
• Hyperuricemia (drug therapy)
• Male
• Renal Dialysis
• Singapore
• Treatment Outcome
• Tumor Lysis Syndrome (physiopathology, urine)
• Urate Oxidase (metabolism, pharmacology)
• Uric Acid (analysis, blood)