title: Rasburicase for hyperuricemia in hemolytic uremic syndrome.
abstract: BACKGROUND
  Acute kidney injury (AKI) with elevated serum uric acid (UA) levels has been reported in patients with hemolytic uremic syndrome (HUS). AKI is thought to result from tubular obstruction by UA crystals. Inducing a diuresis may ameliorate the oligoanuria in such patients. We describe a child with HUS in whom reducing UA with fluids and rasburicase appeared to accelerate the recovery of renal function.
  
  
  METHODS
  A 9-month-old Caucasian male infant presented with 6 days of diarrhea, 3 days of vomiting, and 24 h of oliguria. On admission, hemoglobin was 8.3 g/dL, platelet count 36,000/L, blood urea nitrogen 73 mg/dL, and serum creatinine (SCr) 2.7 mg/dL. Diarrhea-associated HUS was diagnosed. The day after admission, SCr was 2.9 mg/dL and UA 12.3 mg/dL. On hospital day 2, he received a dose of intravenous rasburicase 0.18 mg/kg, and less than 12 h later, the UA had fallen to 0.3 mg/dL. The SCr level also started to fall, and urine output progressively increased without the use of diuretics. Renal function continued to improve, and the UA level remained normal despite ongoing hemolysis requiring a second red blood cell transfusion on hospital day 5. The patient was discharged on hospital day 7 in good physical condition. Two months later, he was in good health, with a SCr level of 0.2 mg/dL and UA of 4.2 mg/dL.
  
  
  CONCLUSIONS
  We postulate that aggressive management of the high serum UA level with rasburicase and fluid hydration accelerated the recovery of our patient. Further studies are needed to determine the role of rasburicase in the treatment of hyperuricemia in patients with HUS.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Scott & White Children's Hospital/Texas A&M Health Science Center College of Medicine, Temple, TX 76508, USA. aacosta@swmail.sw.org
authors.forename: Alisa A
authors.initials: AA
authors.lastname: Acosta
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Hogg
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D003404:Creatinine / Q000097:blood; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D033461:Hyperuricemia / Q000150:complications / Q000188:drug therapy*; D007223:Infant; D008297:Male; D014503:Urate Oxidase / Q000627:therapeutic use*; D014527:Uric Acid / Q000097:blood
chemical_list: C469709:rasburicase; D014527:Uric Acid; D003404:Creatinine; D014503:Urate Oxidase
references.citation: Clin Nephrol. 1990 Jul;34(1):22-5
references.pmid: 2387099
references.citation: Pediatr Crit Care Med. 2011 Nov;12(6):e424-7
references.pmid: 21572370
references.citation: Pediatr Nephrol. 2010 Feb;25(2):305-9
references.pmid: 19936796
references.citation: Am J Dis Child. 1976 Aug;130(8):854-6
references.pmid: 941885
references.citation: Eur Rev Med Pharmacol Sci. 2007 May-Jun;11(3):179-84
references.pmid: 17970234
references.citation: Pediatrics. 2005 Jun;115(6):e673-80
references.pmid: 15930195
references.citation: Iran J Kidney Dis. 2011 Mar;5(2):130-2
references.pmid: 21368393
references.citation: West J Med. 1981 Mar;134(3):193-7
references.pmid: 7269554
references.citation: Blood. 2001 May 15;97(10):2998-3003
references.pmid: 11342423
references.citation: J Clin Invest. 1977 May;59(5):786-93
references.pmid: 16037
references.citation: Clin Nephrol. 1988 Oct;30(4):207-10
references.pmid: 3214966
references.citation: Pediatr Nephrol. 2008 Oct;23(10):1749-60
references.pmid: 18704506
references.citation: Arch Pediatr Adolesc Med. 2011 Oct;165(10):884-9
references.pmid: 21784993
references.citation: J Clin Invest. 1976 Sep;58(3):681-9
references.pmid: 956394