Nephrology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain.
Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain.
Int J Mol Sci. 2024 Mar 15;25(6):3329. doi: 10.3390/ijms25063329.
Cardiorenal syndrome (CRS) involves joint dysfunction of the heart and kidney. Acute forms share biochemical alterations like hyperuricaemia (HU) with tumour lysis syndrome (TLS). The mainstay treatment of acute CRS with systemic overload is diuretics, but rasburicase is used in TLS to prevent and treat hyperuricaemia. An observational, retrospective study was performed to assess the effectiveness and safety of a single dose of rasburicase in hospitalized patients with cardiorenal syndrome, worsening renal function and uric acid levels above 9 mg/dL. Rasburicase improved diuresis and systemic congestion in the 35 patients included. A total of 86% of patients did not need to undergo RRT, and early withdrawal was possible in the remaining five. Creatinine (Cr) decreased after treatment with rasburicase from a peak of 3.6 ± 1.27 to 1.79 ± 0.83 mg/dL, and the estimated glomerular filtration rate (eGFR) improved from 17 ± 8 to 41 ± 20 mL/min/1.73 m ( = 0.0001). The levels of N-terminal type B Brain Natriuretic Peptide (Nt-ProBNP) and C-reactive protein (CRP) were also significantly reduced. No relevant adverse events were detected. Our results show that early treatment with a dose of rasburicase in patients with CRS and severe HU is effective to improve renal function and systemic congestion, avoiding the need for sustained extrarenal clearance, regardless of comorbidities and ventricular function.
心脏肾脏综合征（CRS）涉及心脏和肾脏的联合功能障碍。急性形式具有与肿瘤溶解综合征（TLS）相同的生化改变，如高尿酸血症（HU）。治疗全身性超负荷的急性 CRS 的主要方法是利尿剂，但 rasburicase 用于 TLS 以预防和治疗高尿酸血症。一项观察性、回顾性研究评估了单次剂量 rasburicase 在心脏肾脏综合征、肾功能恶化和尿酸水平超过 9mg/dL 的住院患者中的疗效和安全性。rasburicase 改善了 35 例患者的利尿和全身充血情况。总共 86%的患者不需要进行 RRT，其余 5 例可以早期撤药。治疗后 rasburicase 使肌酐（Cr）从峰值 3.6 ± 1.27 降至 1.79 ± 0.83mg/dL，估算肾小球滤过率（eGFR）从 17 ± 8 提高至 41 ± 20mL/min/1.73m（=0.0001）。N-末端 B 型脑利钠肽（Nt-ProBNP）和 C-反应蛋白（CRP）的水平也显著降低。未发现相关不良事件。我们的结果表明，在 CRS 和严重 HU 患者中早期使用 rasburicase 剂量可有效改善肾功能和全身充血，避免需要持续的肾外清除，无论合并症和心室功能如何。
