Reversal of Severe Volume Deplete Acute Kidney Injury by Rasburicase

We report on a case of acute kidney injury in a patient with severe volume depletion from high ileostomy output and poor oral intake associated with hyperuricemia and hyperkalemia. The patient presented with similar features on three separate admissions. A conservative management approach was undertaken that included infusion of rasburicase, since the patient refused to undergo hemodialysis on each occasion. Rasburicase is a recombinant urate oxidase enzyme that converts uric acid to allantoin which is five to ten times more soluble than uric acid in urine, thereby enhancing urinary excretion. Rasburicase was administered each time and was followed by a prompt increase in urine output, rapid decrease in serum uric acid level, and recovery of renal function without the need for acute renal replacement therapy. We believe that rasburicase, with a molecular weight of 34 kDa, crossed the glomerular filtration barrier and entered the tubular fluid where it dissolved intra-tubular uric acid, thus relieving obstruction, thereby rapidly enhancing urine excretion and improving renal function. Based on this experience, we propose that rasburicase offers an alternative treatment for acute kidney injury in similar types of settings. To the best of our knowledge this is the first reported case in this situation.

Rasburicase in treating tumor lysis syndrome:An umbrella review

Tumor lysis syndrome(TLS)remains a debilitating cause of hospitalization and death in patients with cancer and is a significant challenge for healthcare providers despite advancements in its management.This umbrella review analyzed the results of meta-analyses on the use of rasburicase in the treatment of patients with cancer.A literature search was performed of five databases(PubMed,Google Scholar,Cochrane Library,Scopus,Global Index Medicus,and ScienceDirect)for articles with full texts available online.A measurement tool to assess systematic reviews 2(AMSTAR 2)was used to assess the quality of the included studies,and Review Manager software was used to conduct all statistical analyses.The systematic search identified eight relevant meta-analyses,with primary analyses including outcome data that analyzed mortality,renal failure,and comparisons with allopurinol.The pooled data showed that rasburicase effectively reduced TLS development and serum uric acid levels in children and adults with malignancies.Most outcomes did not differ significantly compared with those of allopurinol.Future trials should focus on the cost-effectiveness of rasburicase compared to that of allopurinol while including high-,intermediate-,and low-risk patients.Rasburicase is safe and effective for managing patients with TLS.However,recent large-scale meta-analyses have reported conflicting results.Most meta-analyses were graded as low to critically low as per AMSTAR 2.The analysis revealed that the benefit of rasburicase did not differ significantly from that of allopurinol,which has higher cost-effectiveness and fewer side effects.