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Rasburicase improves the outcome of acute kidney injury from typical hemolytic uremic syndrome

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Abstract

Background

Typical hemolytic uremic syndrome (HUS) causes acute kidney injury (AKI) and serious sequelae of chronic kidney disease (CKD) in some. Hyperuricemia is a common finding in typical HUS that may contribute to kidney damage. We explored whether aggressive management of hyperuricemia with rasburicase could improve outcomes in AKI patients with typical HUS.

Methods

We retrospectively analyzed medical records of children with typical HUS admitted to a tertiary center between 2005 and 2017. We compared clinical outcomes of hospitalization and 1-year post-discharge between those with rasburicase treatment (n = 13) and those without (controls, n = 29).

Results

With rasburicase treatment, hyperuricemia corrected more rapidly (median 36 vs. 120 h, p < 0.001), and hospital stays were shorter (median 9 vs. 12 days, p = 0.003) than in the controls. There was no difference in dialysis requirement. At 1-year post-discharge, the proportion of patients with impaired kidney function (estimated glomerular filtration rate < 90 mL/min/1.73 m2) was lower in the rasburicase group (7.7% vs. 41.4%, p = 0.036) than in the controls. Hypertension and proteinuria tended to be more common in the controls than in the rasburicase group. Collectively, long-term renal sequelae of impaired kidney function, proteinuria, or hypertension at a 1-year follow-up was less common in the rasburicase group than in the controls (7.7% vs. 62.1%; p = 0.001).

Conclusions

Children with typical HUS treated with rasburicase had shorter hospital stays and less long-term sequelae at 1-year post-discharge than those who were not treated with rasburicase. These results support the use of rasburicase to prevent CKD in pediatric patients with typical HUS-associated AKI.

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Author information

Author notes

  1. Myung Hyun Cho and Yo Han Ahn contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea

    Myung Hyun Cho

  2. Department of Pediatrics, Seoul National University Children’s Hospital & College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Yo Han Ahn, Seon hee Lim, Il-Soo Ha, Hae Il Cheong & Hee Gyung Kang

  3. Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Ji Hyun Kim

  4. Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea

    Il-Soo Ha, Hae Il Cheong & Hee Gyung Kang

  5. Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea

    Il-Soo Ha & Hee Gyung Kang

  6. Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea

    Hee Gyung Kang

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  1. Myung Hyun Cho
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Correspondence to Hee Gyung Kang.

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The study was approved by the Seoul Nation University Hospital institutional review board (H-1711-012-895). Due to the characteristics of the study, informed consent from the patients was waived.

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Cho, M.H., Ahn, Y.H., Lim, S.h. et al. Rasburicase improves the outcome of acute kidney injury from typical hemolytic uremic syndrome. Pediatr Nephrol 35, 2183–2189 (2020). https://doi.org/10.1007/s00467-020-04644-x

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  • DOI: https://doi.org/10.1007/s00467-020-04644-x

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