Rasburicase improves hyperuricemia in patients with acute kidney injury secondary to rhabdomyolysis caused by ecstasy intoxication and exertional heat stroke

Abstract

Rasburicase seems to be a safe and effective drug for improving hyperuricemia in patients with rhabdomyolysis and renal failure.

Rasburicase for hyperuricemia in hemolytic uremic syndrome

“…This decrease in serum UA was associated with a concurrent increase in urine output and decrease in SCr level. The events described by Hooman and Otukesh [8] and Lin et al [9] were similar to the situation in our patient, albeit each with a different etiology. Although a definitive statement regarding the benefit of decreasing the serum UA cannot be made in any of these cases, we believe that the sequence of events makes the benefit of this treatment highly probable.…”

“…Additional experience giving rasburicase to children with AKI was recently reported by Lin et al [9]. These authors gave a single low dose of the drug (0.09 mg/kg approximately) to two children who presented with AKI secondary to rhabdomyolysis that was caused by ecstasy intoxication and heat stroke.…”

“…As a result, rasburicase induces a rapid decrease in the concentration of UA that is preformed, a situation that has particular relevance for patients who have severe hyperuricemia and AKI. No significant adverse events from rasburicase were encountered in the pediatric studies quoted above [6][7][8][9][10], although anaphylaxis is recognized as a potential severe adverse event. In this report, we describe a child with diarrheaassociated HUS and hyperuricemia in whom one dose of rasburicase induced a rapid reduction in serum UA associated with a prompt recovery of renal function.…”

“…In contrast to allopurinol, the uricolytic agent, rasburicase, has been shown to have a dramatic effect on serum UA levels to prevent tumor lysis syndrome in children with cancer [6] and to improve renal function in infants and children who have high UA levels that are associated with acute renal failure resulting from a number of other causes [7][8][9]. The more rapid effect of rasburicase on serum UA levels in patients with hyperuricemia, when compared to allopurinol, results from the different mode and speed of action of the two drugs.…”

Reversal of Severe Volume Deplete Acute Kidney Injury by Rasburicase

“…Repeat abdominal CT scans after rasburicase therapy confirmed complete resolution of uric acid stones with no obstructtion to the urinary tract [14]. A successful outcome following the use of rasburicase has now been reported in an anuric pediatric patient with hyperuricemia in the setting of the hemolytic uremic syndrome [15], and in two teens with acute kidney injury secondary to rhabdomyolysis caused by ecstasy intoxication [16]. In all these settings and now in the patient we report, rasburicase most likely dissolved intra-tubular uric acid, thus relieving obstruction, thereby rapidly enhancing urine excretion and improving renal function.…”