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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Urate-oxidase is an enzyme that metabolizes uric acid into allantoin&#44; which is more soluble and can be eliminated in the urine&#46; Rasburicase is a recombinant form of the enzyme&#46; It is used to prevent uric acid nephropathy from tumoral lysis syndrome&#44; which appears after tumor treatment&#44; mostly of hematologic nature&#46;<span class="elsevierStyleSup">1&#44;2</span> It produces a rapid decrease of serum uric acid levels&#44; and reduces the amount to be filtered in the kidney&#46; That shortens the time of evolution of the renal failure and promotes renal function recovery&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">It has been also used in chronic tophaceous gout and the preliminary results seem promising&#46;<span class="elsevierStyleSup">4-6</span> Vogt<span class="elsevierStyleSup">4</span> described a woman with a renal transplant who presented inflammatory tophi in the hands&#44; which were very disabling&#46; After receiving Rasburicase the serum uric acid level returned to normal and the tophi volume was reduced&#44; with no adverse events&#46; Some authors suggest that Rasburicase can be an alternative if allopurinol or benzobromarone are contraindicated<span class="elsevierStyleSup">7&#44; 8</span>&#46;</p><p class="elsevierStylePara">Obstructive acute renal failure is very frequent among hospitalized patients&#44; with an incidence of 3&#46;8&#37;&#46;<span class="elsevierStyleSup">9 </span>However&#44; the exact incidence of obstructive acute renal failure secondary to lithiasis is unknown&#44; although in some series it is recognized in 3&#46;2&#37; of cases of end-stage renal disease&#44; and the uric acid is the cause of 17&#46;8&#37; of those cases&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">If the efficacy of Rasburicase to dissolve uric acid lithiasis were proved&#44; it could allow reducing the size of the stones promoting their elimination&#46; In this way&#44; manipulation of the urinary tract can be avoided and the renal failure resolved&#46;</p><p class="elsevierStylePara">We present two cases of obstructive acute renal failure with lithiasis that required hemodialysis and that resolved almost immediately after Rasburicase administration&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 1</span></p><p class="elsevierStylePara">A 28 year-old male with history of hyperuricemia and intolerance to acetaminophen and non-steroidal anti-inflammatory drugs went to the Emergency Room because of left nephritic colic and hematuria&#46; In the last 36 hours he became anuric&#46; The analytical findings disclosed a mild renal failure &#40;Cr 2&#46;5 mg&#47;dL&#41;&#46; The ultrasound investigation showed a left kidney of 17 cm with pelvic&#44; calyx and proximal ureter dilatation&#44; multiple small lithiases within the lower calyx groups and absence of the right kidney&#46; The CT scan confirmed these findings and showed abdominal ureter dilatation&#46; The patient was considered as having an obstructive uropathy due to lithiasis&#44; because of hematuria and lumbar pain&#46; He underwent a ureteral catheterization that was unsuccessful&#46; The anuria persisted and the renal function further deteriorated &#40;Cr 8 mg&#47;dL&#41;&#46; A venous catheter was placed and hemodialysis was carried out&#46; Hyperuricemia of 17&#46;6 was detected and a decision was made to treat with Rasburicase &#40;0&#46;20 mg&#47;kg&#47;day&#41; for 2 days&#46; A few hours after the first dose&#44; important polyuria &#40;10 L in 18 hours&#41; developed&#46; In the next days it progressively decreased &#40;fig&#46; 1&#41;&#46; Renal function improved dramatically and hemodialysis could be discontinued&#46; Once the clinical picture had resolved&#44; the abdominal CT scan showed neither pelvic nor ureter dilatation</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 2</span></p><p class="elsevierStylePara">A 70 year-old male is presented with a history of upper gastrointestinal tract bleeding due to bulbar ulceration and hiatal hernia&#44; high blood pressure and right nephritic colic 4 years ago&#46; At that time&#44; he was informed that the left kidney function was suppressed&#46;</p><p class="elsevierStylePara">A week before admission to the hospital he was treated with non-steroidal anti-inflammatory drugs &#40;meloxicam&#41; because of right nephritic colic&#46; He was evaluated in the Emergency Room for 24 hours for oligo-anuria without fever or hematuria&#46; The blood analysis showed severe renal failure &#40;Cr 7 and urea 167 mg&#47;dL&#41;&#46; The ultrasonic study revealed a right kidney of 13&#46;5 cm with lithiasis within the inferior pole and the pelvis &#40;17 and 15 mm&#44; respectively&#41; and absence of the left kidney&#46; The abdominal CT scan confirmed the presence of lithiasis and showed distal ureter dilatation and cortical atrophy of the left kidney &#40;fig&#46; 2&#41;&#46; Intravenous fluid therapy and diuretics were initiated but the patient remained anuric&#46; Ureteral catheter placement was tried but it was unsuccessful and nephrostomy was not indicated because of insufficient pelvis dilatation&#46; Hemodialysis was carried out after placing a central line&#46; Despite fluid administration an increase in urinary tract dilatation was not observed and a percutaneous nephrostomy could not be performed&#46;&#44; In this setting the decision to administer Rasburicase &#40;0&#46;20 mg&#47;kg&#47;day&#41; for 2 days was made&#46; Six hours after the beginning of the therapy the diuresis was recovered&#46; The patient presented polyuria &#40;6 L in the first night&#41; that progressively decreased in the next days&#46; The renal function improved very fast and hemodialysis could be discontinued &#40;fig&#46; 3&#41;&#46; A few days later the abdominal CT scan showed the disappearance of the lithiasis within the right ureter&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Renal disease produced by uric acid can be due to lithiasic urinary tract obstruction&#44; to intra-tubular precipitation of uric acid crystals &#40;in case of overproduction as in tumoral lysis syndrome&#41; or to interstitial nephropathy &#40;as in hyperuricemic nephropathy&#41;&#46; Besides&#44; uric acid stones usually contain a uric core frequently covered by deposition of calcium oxalate crystals&#44; which favors the growth of the calculi and modifies the radiological characteristics&#46;</p><p class="elsevierStylePara">Making the differential diagnosis between them requires bringing together the underlying pathology of the patient&#44; the clinical setting in which it occurs&#44; the radiological findings&#44; the analytical parameters&#44; and the clinical progression itself observed during the recovery phase of renal damage&#46;</p><p class="elsevierStylePara">In both cases there was a high suspicion of obstructive renal failure&#44; because of sudden anuria&#44; hematuria and lumbar pain &#40;case 2&#41;&#44; urinary tract dilatation&#44; and lithiasis images&#44; and especially the rapidity and pace of restoration of the diuresis&#46; In both cases we were witnesses of the abrupt reappearance of the diuresis&#44; which clearly reminds the release of the urinary tract after short-termed obstruction&#44; accompanied by a reduction in ureteral dilatation in radiological images&#44; which supports the diagnosis of acute obstructive renal failure&#46;</p><p class="elsevierStylePara">In case 1 very high serum levels of uric acid were detected&#46; Therefore it could be hypothesized that the acute renal failure was due to intra-tubular uric acid precipitation&#46; However&#44; in cases of uric acid precipitation the renal function recovery is slow&#44; the diuresis volumes grow progressively and the serum levels of the nitrogenous products also decrease gradually&#46; On the contrary&#44; in the presented patient the recovery was very abrupt&#46;</p><p class="elsevierStylePara">The clear and surprising temporal relationship between the administration of Rasburicase and the reappearance of the diuresis can be a clue to understand the underlying mechanism for the renal failure resolution&#46; We cannot be sure of the nature of the stones but it is possible that they were composed of uric acid&#46; First&#44; they could not be seen in the plain X-ray film&#46; Second&#44; in case 1&#44; there was hyperuricemia and the possibility that the stone was of uric acid seems likely&#46; Besides&#44; in case 2 the lithiasis could be mixed in nature with a uric acid core&#46; We postulate that Rasburicase reduced the stone size enough to allow it moving and passing through the narrowest part&#44; which is the distal ureter&#46;</p><p class="elsevierStylePara">Rasburicase must be able to reach the urinary tract passing through the glomerular filter to be efficacious&#46; Sixty percent of the proteins present in the urine are of plasmatic origin and that means that they are able to cross this barrier&#46;<span class="elsevierStyleSup">11</span> The permeability of the filtration membrane depends on the charge&#44; the size and the form of the molecule&#44; and each one has a characteristic glomerular sieving coefficient&#46; Many studies have shown that the albumin&#44; with a molecular weight of 69 kDa&#44; does not cross the glomerular filter&#44;<span class="elsevierStyleSup">12</span> although it can actually be detected in the urine in very small quantities &#40;15-20 mg&#47;kg in females and 18-25 mg&#47;kg in males&#41;&#46; Norden13 measured the sieving coefficient of 12 plasmatic proteins in humans and found a clear relation with the molecular weight&#46; The &#945;1-microglobulin with a weight of 31 kDa had a greater coefficient than the albumin&#46; That allows hypothesizing that Rasburicase&#44; with a molecular weight of 34 kDa&#44; can be present in the urine&#46;</p><p class="elsevierStylePara">Therefore&#44; Rasburicase is theoretically able to pass through the glomerular filter and be eliminated in the urine in a significant quantity&#46; In this way it acts on intra-tubular uric acid&#44; dissolves the crystals and promotes their elimination&#46; This mechanism helps to shorten the evolution of the acute established renal failure in case of tumoral lysis syndrome&#46;<span class="elsevierStyleSup">3&#44; 14</span> We also hypothesize that Rasburicase can reach the urinary tract and dissolve the stones with a uric acid component within the calyces&#44; pelvis and ureter&#44; favoring their elimination&#46; If the capability of Rasburicase to dissolve uric acid stones is confirmed either in vitro or in vivo&#44; the direct administration of the drug in the urinary tract through nephrostomy catheters could be a new therapeutic approach in patients with this common pathology&#46; </p>"
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        "resumen" => "La incidencia global de la insuficiencia renal cr&#243;nica o aguda asociada a la litiasis renal es desconocida y probablemente est&#233; infraestimada&#46; Sin embargo&#44; la uropat&#237;a obstructiva constituye una causa potencialmente curable de nefropat&#237;a que precisa con frecuencia manipulaci&#243;n quir&#250;rgica de la v&#237;a urinaria&#46; Rasburicasa es una enzima recombinante que metaboliza el &#225;cido &#250;rico en alanto&#237;na&#44; un compuesto m&#225;s hidrosoluble y f&#225;cilmente eliminable por el ri&#241;&#243;n&#46; Su principal indicaci&#243;n es la prevenci&#243;n de la nefropat&#237;a por &#225;cido &#250;rico del s&#237;ndrome de lisis tumoral&#46; Pero&#44; actualmente&#44; tambi&#233;n se considera una posible alternativa al alopurinol en el manejo de la hiperuricemia del paciente con gota tof&#225;cea cr&#243;nica&#46; Presentamos dos casos de fracaso renal agudo an&#250;rico obstructivo provocados por litiasis que precisaron hemodi&#225;lisis y a los que se les administr&#243; rasburicasa por v&#237;a intravenosa &#40;0&#44;20 mg&#47;kg&#47;d&#237;a durante 2 d&#237;as&#41;&#46; Tras 12-18 horas se observ&#243; una poliuria brusca y eficaz que se acompa&#241;&#243; de r&#225;pida recuperaci&#243;n de la funci&#243;n renal y permiti&#243; suspender la hemodi&#225;lisis&#46; En virtud del relativo bajo peso molecular de la rasburicasa podemos suponer que es capaz de atravesar el filtro glomerular y aparecer en la orina&#46; Podr&#237;a as&#237; disolver los cristales de &#225;cido &#250;rico formados en el fracaso renal agudo asociado al s&#237;ndrome de lisis tumoral&#46; Pero tambi&#233;n podemos hipotetizar que la rasburicasa actuar&#237;a en la v&#237;a urinaria fragmentando los c&#225;lculos&#44; facilitando su eliminaci&#243;n y liberando la obstrucci&#243;n&#44; lo que posibilitar&#237;a la resoluci&#243;n del fallo renal&#46; Sugerimos que la rasburicasa deber&#237;a ser ensayada con esta nueva indicaci&#243;n para probar su posible eficacia&#46;"
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                  "referenciaCompleta" => "Bosly A, Sonet A, Pinkerton CR, McCowage G, Bron D, Sanz MA, Van den Berg H. Rasburicase (recombinant urate oxidase) for the management of hyperuricemia in patients with Cancer: report of an international compassionate use study. Cancer 98 (5): 1048-54, 2003. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12942574" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Zaidi S, Aljurf M. Is rasburicase needed for prevention of tumor lysis syndrome during treatment of less aggressive hematolymphoid malignancies? Journal of Clinical Oncology 22 (16): 3430-3431, 2004. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15310789" target="_blank">[Pubmed]</a>"
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Efficacy of rasburicase therapy in obstructive renal failure secondary to urolithiasis: a novel therapeutic option
Eficacia de la rasburicasa en el fracaso renal agudo obstructivo por litiasis: una nueva opción terapéutica
Pilar Segura Torresa, F. J.. Borrego Utiela, P.. Pérez del Barrioa, J. M.. Gil Cunqueroa, V.. Pérez Bañascoa
a Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, Jaén, España,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Urate-oxidase is an enzyme that metabolizes uric acid into allantoin&#44; which is more soluble and can be eliminated in the urine&#46; Rasburicase is a recombinant form of the enzyme&#46; It is used to prevent uric acid nephropathy from tumoral lysis syndrome&#44; which appears after tumor treatment&#44; mostly of hematologic nature&#46;<span class="elsevierStyleSup">1&#44;2</span> It produces a rapid decrease of serum uric acid levels&#44; and reduces the amount to be filtered in the kidney&#46; That shortens the time of evolution of the renal failure and promotes renal function recovery&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">It has been also used in chronic tophaceous gout and the preliminary results seem promising&#46;<span class="elsevierStyleSup">4-6</span> Vogt<span class="elsevierStyleSup">4</span> described a woman with a renal transplant who presented inflammatory tophi in the hands&#44; which were very disabling&#46; After receiving Rasburicase the serum uric acid level returned to normal and the tophi volume was reduced&#44; with no adverse events&#46; Some authors suggest that Rasburicase can be an alternative if allopurinol or benzobromarone are contraindicated<span class="elsevierStyleSup">7&#44; 8</span>&#46;</p><p class="elsevierStylePara">Obstructive acute renal failure is very frequent among hospitalized patients&#44; with an incidence of 3&#46;8&#37;&#46;<span class="elsevierStyleSup">9 </span>However&#44; the exact incidence of obstructive acute renal failure secondary to lithiasis is unknown&#44; although in some series it is recognized in 3&#46;2&#37; of cases of end-stage renal disease&#44; and the uric acid is the cause of 17&#46;8&#37; of those cases&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">If the efficacy of Rasburicase to dissolve uric acid lithiasis were proved&#44; it could allow reducing the size of the stones promoting their elimination&#46; In this way&#44; manipulation of the urinary tract can be avoided and the renal failure resolved&#46;</p><p class="elsevierStylePara">We present two cases of obstructive acute renal failure with lithiasis that required hemodialysis and that resolved almost immediately after Rasburicase administration&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 1</span></p><p class="elsevierStylePara">A 28 year-old male with history of hyperuricemia and intolerance to acetaminophen and non-steroidal anti-inflammatory drugs went to the Emergency Room because of left nephritic colic and hematuria&#46; In the last 36 hours he became anuric&#46; The analytical findings disclosed a mild renal failure &#40;Cr 2&#46;5 mg&#47;dL&#41;&#46; The ultrasound investigation showed a left kidney of 17 cm with pelvic&#44; calyx and proximal ureter dilatation&#44; multiple small lithiases within the lower calyx groups and absence of the right kidney&#46; The CT scan confirmed these findings and showed abdominal ureter dilatation&#46; The patient was considered as having an obstructive uropathy due to lithiasis&#44; because of hematuria and lumbar pain&#46; He underwent a ureteral catheterization that was unsuccessful&#46; The anuria persisted and the renal function further deteriorated &#40;Cr 8 mg&#47;dL&#41;&#46; A venous catheter was placed and hemodialysis was carried out&#46; Hyperuricemia of 17&#46;6 was detected and a decision was made to treat with Rasburicase &#40;0&#46;20 mg&#47;kg&#47;day&#41; for 2 days&#46; A few hours after the first dose&#44; important polyuria &#40;10 L in 18 hours&#41; developed&#46; In the next days it progressively decreased &#40;fig&#46; 1&#41;&#46; Renal function improved dramatically and hemodialysis could be discontinued&#46; Once the clinical picture had resolved&#44; the abdominal CT scan showed neither pelvic nor ureter dilatation</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 2</span></p><p class="elsevierStylePara">A 70 year-old male is presented with a history of upper gastrointestinal tract bleeding due to bulbar ulceration and hiatal hernia&#44; high blood pressure and right nephritic colic 4 years ago&#46; At that time&#44; he was informed that the left kidney function was suppressed&#46;</p><p class="elsevierStylePara">A week before admission to the hospital he was treated with non-steroidal anti-inflammatory drugs &#40;meloxicam&#41; because of right nephritic colic&#46; He was evaluated in the Emergency Room for 24 hours for oligo-anuria without fever or hematuria&#46; The blood analysis showed severe renal failure &#40;Cr 7 and urea 167 mg&#47;dL&#41;&#46; The ultrasonic study revealed a right kidney of 13&#46;5 cm with lithiasis within the inferior pole and the pelvis &#40;17 and 15 mm&#44; respectively&#41; and absence of the left kidney&#46; The abdominal CT scan confirmed the presence of lithiasis and showed distal ureter dilatation and cortical atrophy of the left kidney &#40;fig&#46; 2&#41;&#46; Intravenous fluid therapy and diuretics were initiated but the patient remained anuric&#46; Ureteral catheter placement was tried but it was unsuccessful and nephrostomy was not indicated because of insufficient pelvis dilatation&#46; Hemodialysis was carried out after placing a central line&#46; Despite fluid administration an increase in urinary tract dilatation was not observed and a percutaneous nephrostomy could not be performed&#46;&#44; In this setting the decision to administer Rasburicase &#40;0&#46;20 mg&#47;kg&#47;day&#41; for 2 days was made&#46; Six hours after the beginning of the therapy the diuresis was recovered&#46; The patient presented polyuria &#40;6 L in the first night&#41; that progressively decreased in the next days&#46; The renal function improved very fast and hemodialysis could be discontinued &#40;fig&#46; 3&#41;&#46; A few days later the abdominal CT scan showed the disappearance of the lithiasis within the right ureter&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Renal disease produced by uric acid can be due to lithiasic urinary tract obstruction&#44; to intra-tubular precipitation of uric acid crystals &#40;in case of overproduction as in tumoral lysis syndrome&#41; or to interstitial nephropathy &#40;as in hyperuricemic nephropathy&#41;&#46; Besides&#44; uric acid stones usually contain a uric core frequently covered by deposition of calcium oxalate crystals&#44; which favors the growth of the calculi and modifies the radiological characteristics&#46;</p><p class="elsevierStylePara">Making the differential diagnosis between them requires bringing together the underlying pathology of the patient&#44; the clinical setting in which it occurs&#44; the radiological findings&#44; the analytical parameters&#44; and the clinical progression itself observed during the recovery phase of renal damage&#46;</p><p class="elsevierStylePara">In both cases there was a high suspicion of obstructive renal failure&#44; because of sudden anuria&#44; hematuria and lumbar pain &#40;case 2&#41;&#44; urinary tract dilatation&#44; and lithiasis images&#44; and especially the rapidity and pace of restoration of the diuresis&#46; In both cases we were witnesses of the abrupt reappearance of the diuresis&#44; which clearly reminds the release of the urinary tract after short-termed obstruction&#44; accompanied by a reduction in ureteral dilatation in radiological images&#44; which supports the diagnosis of acute obstructive renal failure&#46;</p><p class="elsevierStylePara">In case 1 very high serum levels of uric acid were detected&#46; Therefore it could be hypothesized that the acute renal failure was due to intra-tubular uric acid precipitation&#46; However&#44; in cases of uric acid precipitation the renal function recovery is slow&#44; the diuresis volumes grow progressively and the serum levels of the nitrogenous products also decrease gradually&#46; On the contrary&#44; in the presented patient the recovery was very abrupt&#46;</p><p class="elsevierStylePara">The clear and surprising temporal relationship between the administration of Rasburicase and the reappearance of the diuresis can be a clue to understand the underlying mechanism for the renal failure resolution&#46; We cannot be sure of the nature of the stones but it is possible that they were composed of uric acid&#46; First&#44; they could not be seen in the plain X-ray film&#46; Second&#44; in case 1&#44; there was hyperuricemia and the possibility that the stone was of uric acid seems likely&#46; Besides&#44; in case 2 the lithiasis could be mixed in nature with a uric acid core&#46; We postulate that Rasburicase reduced the stone size enough to allow it moving and passing through the narrowest part&#44; which is the distal ureter&#46;</p><p class="elsevierStylePara">Rasburicase must be able to reach the urinary tract passing through the glomerular filter to be efficacious&#46; Sixty percent of the proteins present in the urine are of plasmatic origin and that means that they are able to cross this barrier&#46;<span class="elsevierStyleSup">11</span> The permeability of the filtration membrane depends on the charge&#44; the size and the form of the molecule&#44; and each one has a characteristic glomerular sieving coefficient&#46; Many studies have shown that the albumin&#44; with a molecular weight of 69 kDa&#44; does not cross the glomerular filter&#44;<span class="elsevierStyleSup">12</span> although it can actually be detected in the urine in very small quantities &#40;15-20 mg&#47;kg in females and 18-25 mg&#47;kg in males&#41;&#46; Norden13 measured the sieving coefficient of 12 plasmatic proteins in humans and found a clear relation with the molecular weight&#46; The &#945;1-microglobulin with a weight of 31 kDa had a greater coefficient than the albumin&#46; That allows hypothesizing that Rasburicase&#44; with a molecular weight of 34 kDa&#44; can be present in the urine&#46;</p><p class="elsevierStylePara">Therefore&#44; Rasburicase is theoretically able to pass through the glomerular filter and be eliminated in the urine in a significant quantity&#46; In this way it acts on intra-tubular uric acid&#44; dissolves the crystals and promotes their elimination&#46; This mechanism helps to shorten the evolution of the acute established renal failure in case of tumoral lysis syndrome&#46;<span class="elsevierStyleSup">3&#44; 14</span> We also hypothesize that Rasburicase can reach the urinary tract and dissolve the stones with a uric acid component within the calyces&#44; pelvis and ureter&#44; favoring their elimination&#46; If the capability of Rasburicase to dissolve uric acid stones is confirmed either in vitro or in vivo&#44; the direct administration of the drug in the urinary tract through nephrostomy catheters could be a new therapeutic approach in patients with this common pathology&#46; </p>"
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        "resumen" => "La incidencia global de la insuficiencia renal cr&#243;nica o aguda asociada a la litiasis renal es desconocida y probablemente est&#233; infraestimada&#46; Sin embargo&#44; la uropat&#237;a obstructiva constituye una causa potencialmente curable de nefropat&#237;a que precisa con frecuencia manipulaci&#243;n quir&#250;rgica de la v&#237;a urinaria&#46; Rasburicasa es una enzima recombinante que metaboliza el &#225;cido &#250;rico en alanto&#237;na&#44; un compuesto m&#225;s hidrosoluble y f&#225;cilmente eliminable por el ri&#241;&#243;n&#46; Su principal indicaci&#243;n es la prevenci&#243;n de la nefropat&#237;a por &#225;cido &#250;rico del s&#237;ndrome de lisis tumoral&#46; Pero&#44; actualmente&#44; tambi&#233;n se considera una posible alternativa al alopurinol en el manejo de la hiperuricemia del paciente con gota tof&#225;cea cr&#243;nica&#46; Presentamos dos casos de fracaso renal agudo an&#250;rico obstructivo provocados por litiasis que precisaron hemodi&#225;lisis y a los que se les administr&#243; rasburicasa por v&#237;a intravenosa &#40;0&#44;20 mg&#47;kg&#47;d&#237;a durante 2 d&#237;as&#41;&#46; Tras 12-18 horas se observ&#243; una poliuria brusca y eficaz que se acompa&#241;&#243; de r&#225;pida recuperaci&#243;n de la funci&#243;n renal y permiti&#243; suspender la hemodi&#225;lisis&#46; En virtud del relativo bajo peso molecular de la rasburicasa podemos suponer que es capaz de atravesar el filtro glomerular y aparecer en la orina&#46; Podr&#237;a as&#237; disolver los cristales de &#225;cido &#250;rico formados en el fracaso renal agudo asociado al s&#237;ndrome de lisis tumoral&#46; Pero tambi&#233;n podemos hipotetizar que la rasburicasa actuar&#237;a en la v&#237;a urinaria fragmentando los c&#225;lculos&#44; facilitando su eliminaci&#243;n y liberando la obstrucci&#243;n&#44; lo que posibilitar&#237;a la resoluci&#243;n del fallo renal&#46; Sugerimos que la rasburicasa deber&#237;a ser ensayada con esta nueva indicaci&#243;n para probar su posible eficacia&#46;"
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        "resumen" => "The overall incidence of nephrolithiasis-related acute and chronic renal failure is poorly known and surely underestimated&#46; However&#44; obstructive nephropathy represents a potentially curable form of kidney disease that often requires for managing an instrumentation of urinary tract&#46; Rasburicase is an enzyme that transforms uric acid to allantoin&#44; a compound more water soluble that will be excreted by the kidney more easily&#46; Rasburicase has been proven to be an effective therapy for prevention of tumour lysis syndrome&#46; But it also represents an interesting new option in managing hyperuricemia in patients with severe tophaceous gout&#46; We administered rasburicase intravenously &#40;0&#44;20 mg&#47;kg&#47;day&#44; for 2 days&#41; in 2 adults with acute obstructive nephropathy from renal calculi&#44; which was receiving temporary haemodialysis&#46; Rasburicase produced a sharp polyuria 12-18 hours after its administration accompanied with a fast reduction of serum creatinine levels&#44; that returned to normal range without further dialysis&#46; If we suppose that rasburicase can pass through glomerular filter by its relatively low molecular weight&#44; it could disolve tubular uric acid crystals in acute renal failure associated to tumour lysis syndrome&#44; providing the restoration of renal function&#46; But we also could postulate that rasburicase can act in urinary tract&#44; fragmentating renal calculi&#44; promoting relief of obstructive uropathy and the resolution of renal failure&#46; We suggest rasburicase should be tried in this new indication to prove its potential efficacy&#46;"
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                  "referenciaCompleta" => "Bosly A, Sonet A, Pinkerton CR, McCowage G, Bron D, Sanz MA, Van den Berg H. Rasburicase (recombinant urate oxidase) for the management of hyperuricemia in patients with Cancer: report of an international compassionate use study. Cancer 98 (5): 1048-54, 2003. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12942574" target="_blank">[Pubmed]</a>"
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Article information
ISSN: 20132514
Original language: English
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