Xanthine Nephropathy in a Patient with Lymphosarcoma Treated with Allopurinol

Pr, Band; Ds, Silverberg; Jf, Henderson; Ra, Ulan; Rh, Wensel; Tk, Banerjee; As, Little

doi:10.1056/nejm197008132830708

Cited by 165 publications

(55 citation statements)

References 6 publications

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“…However, it may take several days for uric acid levels to normalize and the increases in xanthine levels may lead to xanthine nephropathy and urolithiasis. [5][6][7] An alternative treatment with a more rapid onset of action is the enzyme urate oxidase. Endogenous urate oxidase is present in many mammalian species, but not in humans.…”

Section: Introductionmentioning

confidence: 99%

Recombinant urate oxidase (rasburicase) in the prevention and treatment of malignancy-associated hyperuricemia in pediatric and adult patients: results of a compassionate-use trial

et al. 2001

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To confirm the efficacy of recombinant urate oxidase (rasburicase) and to establish its safety profile, we reviewed the data on 173 children and 72 adults with malignancy who were treated with this new uricolytic agent in a compassionateuse trial. Rasburicase (0.20 mg/kg) was administered intravenously daily for 1 to 7 days and could be given every 12 h for the initial 72 h. Subsequent courses were allowed at a later date. Rasburicase produced a dramatic decrease in uric acid concentrations in all patients whether they received it for prophylaxis (n = 79) or treatment (n = 166) (P Ͻ 0.001 in all comparisons between the levels at diagnosis and those after treatment). The median post-treatment levels were 0.5 to 0.7 mg/dl. Repeated administrations were also effective in all 11 evaluable patients. Four children and five adults had mild adverse reactions that were drug related or of unknown etiology. In two of the children, the adverse events occurred during the second course. Rasburicase is highly effective and safe in the prophylaxis or treatment of malignancy-or chemotherapyassociated hyperuricemia in children and adults. Leukemia (2001) 15, 1505-1509.

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Section: Introductionmentioning

confidence: 99%

Recombinant urate oxidase (rasburicase) in the prevention and treatment of malignancy-associated hyperuricemia in pediatric and adult patients: results of a compassionate-use trial

et al. 2001

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“…9 In fact, occasional case reports of Chemotherapy xanthine nephropathy and calculi suggest that allopurinol treatment is detrimental to some patients. [10][11][12][13] Patients with non-B cell ALL receiving non-recombinant urate Urate oxidase, by converting uric acid to allantoin -a readoxidase and historical controls were the subjects of two consecutive Total Therapy studies (XIIIA and XIIIB). with the first dose of urate oxidase treatment and did not receive subsequent doses, were excluded from the analysis.…”

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confidence: 99%

Urate oxidase in prevention and treatment of hyperuricemia associated with lymphoid malignancies

et al. 1997

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Standard prophylaxis and treatment of malignancy-associatedily excretable metabolite with 5-to 10-fold higher solubility hyperuricemia in the USA has been allopurinol with vigorous than uric acid -offers a potentially useful alternative for the hydration, urinary alkalinization and osmotic diuresis. Urate prophylaxis and treatment of hyperuricemia. 14 However, the oxidase, the enzyme that converts uric acid to allantoin (a readnon-recombinant product (Uricozyme; Sanofi Winthrop, ily excreted metabolite that has 5-to 10-fold higher solubility Paris, France) Of 176 patients with non-B cell ALL, five with B cell ALL and Keywords: acute lymphoblastic leukemia; urate oxidase; uric acid; six with stage III or IV B cell NHL who were consecutively hyperuricemia; tumor lysis syndrome admitted to St Jude Children's Research Hospital from February 1994 to December 1996, 126, five and three, respectively, were treated with non-recombinant urate oxidase (Uricozyme, Introduction provided free of charge by Sanofi Winthrop). The enzyme was not given to 43 patients because of a history of allergy (atopic Hyperuricemia, a well-recognized complication of lymphoid allergy, glucose-6-phosphate dehydrogenase deficiency and malignant diseases and their treatment, has been associated pregnancy are listed as contraindications in the Uricozyme with high morbidity rates and delays in the delivery of chemopackage insert), six because they received the new recombitherapy, especially in patients with B cell or T cell acute lymnant urate oxidase (which recently became available for cliniphoblastic leukemia (ALL) and advanced-stage B cell noncal testing in a multicenter clinial trial), and four because they Hodgkin lymphoma (NHL). 1-6 The standard prophylaxis or did not receive methotrexate or 6-mercaptopurine as preintreatment of hyperuricemia in patients with neoplastic disduction therapy. Children with newly diagnosed non-B cell orders consists of allopurinol, vigorous hydration, urinary alk-ALL who were consecutively treated with allopurinol between alinization and osmotic diuresis. [2][3][4][5]7 By inhibiting the enzyme December 1991 and February 1994 served as historical conxanthine oxidase, hence uric acid formation, allopurinol thertrols. Informed consent was obtained from the parents or legal apy reduces the renal load of uric acid but increases the renal guardians of all patients. excretion of the uric acid precursors hypoxanthine and xanthine. 8 Unlike hypoxanthine, xanthine is actually less soluble than uric acid in urine. 9 In fact, occasional case reports of Chemotherapy xanthine nephropathy and calculi suggest that allopurinol treatment is detrimental to some patients. [10][11][12][13] Patients with non-B cell ALL receiving non-recombinant urate Urate oxidase, by converting uric acid to allantoin -a readoxidase and historical controls were the subjects of two consecutive Total Therapy studies (XIIIA and XIIIB). and randomized patients to receive either high-dose metho-

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“…Serum urate levels can be reduced with allopurinol 400 mg/sq m/day at the expense of hypoxanthine accumulation, and xanthine nephropathy has been reported. 8 Worsening respiratory distress is likely to ensue, if a satisfactory diuresis cannot be achieved by the above measures, and early transfer to the Intensive Therapy Unit should be arranged for respiratory monitoring and therapy. Peritoneal or intravascular access may be secured to facilitate dialysis or haemofiltration to remove excess fluid and control rises in serum potassium.…”

Section: Discussionmentioning

confidence: 99%