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Rasburicase improves hyperuricemia in infants with acute kidney injury

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Abstract

Recent data suggest that elevated levels of uric acid (UA) might contribute to the progression of renal disease. Rasburicase, recombinant urate oxidase, is a highly safe and efficacious hypo-uricosuric agent for treatment of elevated UA levels from tumor lysis. We adopted the use of rasburicase for management of hyperuricemia in infants with acute kidney injury (AKI) and, herein, report our experience. We conducted a retrospective chart review of infants with hyperuricemia (UA > 8 mg/dl) secondary to AKI (serum creatinine > 1.5 mg/dl) treated with rasburicase. Seven infants (mean age 34 ± 55 days, six male), with a mean weight of 3.2 ± 1.2 kg, were identified. Rasburicase was administered intravenously as a single, onetime, bolus of 0.17 ± 0.04 mg/kg body weight. Within 24 h, serum UA had decreased from 13.6 ± 4.5 mg/dl to 0.9 ± 0.6 mg/dl (P < 0.05), creatinine had decreased from 3.2 ± 2.0 mg/dl to 2.0 ± 1.2 mg/dl (P < 0.05), and urinary output had increased from 2.4 ± 1.2 ml/kg per hour to 5.9 ± 1.8 ml/kg per hour (P < 0.05). Continued improvements in UA, creatinine, and urinary output were observed in the week following administration of rasburicase, without rebound of the UA. We observed no treatment-related side effects. All patients demonstrated a normalization of uric acid level without need of renal replacement therapy. In conclusion, a single intravenously administered bolus of rasburicase appears to be a novel treatment for hyperuricemia in infants with AKI.

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Acknowledgements

D.J.H. was supported by an American Society of Nephrology student scholar grant. The authors would like to thank David P. Weismantel, M.D., M.S., for statistical support. None of the authors declare a conflict of interest with this research or the information herein.

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Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplantation, Helen DeVos Children’s Hospital and Michigan State University College of Human Medicine, 221 Michigan Street SE, Suite 406, Grand Rapids, MI, 49503, USA

    David J. Hobbs, Julia M. Steinke, Jin Y. Chung, Gina-Marie Barletta & Timothy E. Bunchman

  2. Michigan State University/Grand Rapids Medical Education and Research Center (GRMERC/MSU) Pediatric Nephrology Fellowship Program, GRMERC, Grand Rapids, MI, USA

    Jin Y. Chung

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  1. David J. Hobbs
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  2. Julia M. Steinke
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  3. Jin Y. Chung
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  4. Gina-Marie Barletta
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  5. Timothy E. Bunchman
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Correspondence to Timothy E. Bunchman.

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Hobbs, D.J., Steinke, J.M., Chung, J.Y. et al. Rasburicase improves hyperuricemia in infants with acute kidney injury. Pediatr Nephrol 25, 305–309 (2010). https://doi.org/10.1007/s00467-009-1352-1

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  • DOI: https://doi.org/10.1007/s00467-009-1352-1

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