title: Plasma uric acid response to rasburicase: early marker for acute kidney injury in tumor lysis syndrome?
abstract: Acute kidney injury (AKI) is associated with high morbidity and mortality in tumor lysis syndrome (TLS). The goal of this study was to assess a practical approach involving a simple risk-prediction model for AKI in patients at high risk for clinical TLS treated according to standardized guidelines. We collected data on 62 patients at high risk for clinical TLS. We evaluated whether the magnitude of the plasma uric acid decrease in response to rasburicase predicted AKI. According to RIFLE criteria (Risk, Injury, Failure, sustained Loss, End-stage kidney disease), 41 (66.1%) patients had AKI. AKI was associated with higher hospital (26.8% vs. 0%, p = 0.01) and 6-month (41.4% vs. 9.5%, p = 0.04) mortality. The plasma uric acid decrease after rasburicase was significantly larger in patients who did not develop AKI than in those who did (95% vs. 84%; p < 0.01). By multivariate analysis, independent determinants of AKI were hypertension and a plasma uric acid decrease smaller than 92.9% 6 h after rasburicase.
authors: Medical Intensive Care Unit.
authors: Emmanuel
authors: E
authors: Canet
authors: Morgane
authors: M
authors: Cheminant
authors: Lara
authors: L
authors: Zafrani
authors: Catherine
authors: C
authors: Thieblemont
authors: Lionel
authors: L
authors: Galicier
authors: Etienne
authors: E
authors: Lengline
authors: David
authors: D
authors: Schnell
authors: Danielle
authors: D
authors: Reuter
authors: Michael
authors: M
authors: Darmon
authors: Benoit
authors: B
authors: Schlemmer
authors: Elie
authors: E
authors: Azoulay
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000150:complications* / Q000209:etiology / Q000628:therapy; D014503:Urate Oxidase / Q000627:therapeutic use*; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; C469709:rasburicase; D014527:Uric Acid; D014503:Urate Oxidase
keywords: Tumor lysis syndrome; acute kidney injury; rasburicase