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.
Pediatr Nephrol. 2010 Feb;25(2):305-9. doi: 10.1007/s00467-009-1352-1. Epub 2009 Nov 21.
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.
最近的数据表明，尿酸（UA）水平升高可能导致肾脏疾病的进展。重组尿酸氧化酶 Rasburicase 是一种高度安全有效的低尿酸血症药物，可用于治疗肿瘤溶解导致的 UA 水平升高。我们采用 Rasburicase 治疗急性肾损伤（AKI）婴儿的高尿酸血症，并在此报告我们的经验。我们对接受 Rasburicase 治疗的 AKI 继发高尿酸血症（血清肌酐 > 1.5 mg/dl）婴儿进行了回顾性图表审查。确定了 7 名婴儿（平均年龄 34 +/- 55 天，6 名男性），平均体重为 3.2 +/- 1.2 kg。Rasburicase 以单次静脉推注 0.17 +/- 0.04 mg/kg 体重的方式给予。在 24 小时内，血清 UA 从 13.6 +/- 4.5 mg/dl 降至 0.9 +/- 0.6 mg/dl（P < 0.05），肌酐从 3.2 +/- 2.0 mg/dl 降至 2.0 +/- 1.2 mg/dl（P < 0.05），尿量从 2.4 +/- 1.2 ml/kg/小时增加至 5.9 +/- 1.8 ml/kg/小时（P < 0.05）。在 Rasburicase 给药后一周内观察到 UA、肌酐和尿量持续改善，UA 无反弹。我们没有观察到与治疗相关的副作用。所有患者的尿酸水平均恢复正常，无需肾脏替代治疗。总之，静脉单次推注 Rasburicase 似乎是 AKI 婴儿高尿酸血症的一种新的治疗方法。
