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Rationale:
- Allopurinol prevents formation of uric acid from purine breakdown products of nuclear material. If allopurinol is not given,
uric acid nephropathy with tubular obstruction may occur. Uricosuric drugs are not indicated in this situation.
- Rasburicase promotes the conversion of uric acid to the more soluble allantoin.
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Evidence:
- Allopurinol and hydration are still the standard of care for this potential complication. Urate oxidase and experimental drugs
under development may be useful alternatives (1).
- A high phosphorus-to-uric acid ratio may precede hyperuricemic acute renal failure as a complication of chemotherapy, with
precipitous decreases in peripheral leukocyte counts (2).
- A review of pediatric use of rasburicase has led to FDA approval for prevention of tumor lysis syndrome in high-risk patients
(i.e., those with non-Hodgkin's lymphomas like Burkitt's lymphoma, acute lymphoblastic leukemia, acute myelogenous leukemia),
and its use is standard in these situations (3). Patients who are glucose-6-phosphatase deficient must not be given rasburicase.
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Comments:
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Grace P. Teal, MD (deceased) has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Howard A. Fuchs, MD, is a consultant for TAP Pharmaceuticals.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Gout
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