Renal tubular damage in rasburicase: risks of alkalinisation

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Abstract
It is assumed that tumour lysis syndrome is primarily due to urate precipitation. Due to efficient urate depletion by rasburicase, it is suggested that severe renal damage will be absent [1]. Based on observation of a 7-year-old boy with Burkitt’s lymphoma, needing dialysis, we analysed calcium and phosphate metabolism using rasburicase. The index patient developed anuria, tetany and hyperphosphataemia (8.11 mmol). Creatinin rose from 38 to 188 µmol/l on dialysis. In order to optimise urate excretion, hyperhydration and alkalinisation were given during rasburicase administration (7 days). The first 25 consecutive patients treated with rasburicase were analysed for creatinin and phosphate/calcium disturbances in the first weeks of treatment. Twenty-three children had leukaemia or lymphoma, and two patients had bilateral nephoblastoma or hepatoblastoma.