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


METHODS
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.


RESULTS
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.
Teo
Wan Yee
WY
Department of Paediatric Medicine, KK Women's & Children's Hospital, Singapore.
Loh
Tsee Foong
TF
Tan
Ah Moy
AM
D002051:Burkitt Lymphoma / Q000150:complications; D002648:Child; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy; D008297:Male; D006435:Renal Dialysis; D012846:Singapore; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000503:physiopathology* / Q000652:urine; D014503:Urate Oxidase / Q000378:metabolism* / Q000494:pharmacology; D014527:Uric Acid / Q000032:analysis / Q000097:blood
D014527:Uric Acid; D014503:Urate Oxidase