title: Avoiding dialysis in tumour lysis syndrome: is urate oxidase effective? - a case report and review of literature.
abstract: 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.
authors.affiliation: Department of Paediatric Medicine, KK Women's & Children's Hospital, Singapore.
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Teo
authors.forename: Tsee Foong
authors.initials: TF
authors.lastname: Loh
authors.forename: Ah Moy
authors.initials: AM
authors.lastname: Tan
mesh_terms: 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
chemical_list: D014527:Uric Acid; D014503:Urate Oxidase