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HYPERURICEMIA &TUMOR LYSISSYNDROME
Babak Tamizi Far MD.Assistant professor of internal medicineAl-zahra hospital, Isfahan university ofmedical sciences
Key Features
Complication of rapidlyproliferating malignancies as wellas treatment-associated tumorlysis of hematologic malignancies
May be worsened by thiazidediuretic use
Complication of rapidlyproliferating malignancies as wellas treatment-associated tumorlysis of hematologic malignancies
May be worsened by thiazidediuretic use
Key Features
Rapid increase in serum uric acidcan result in acute uratenephropathy caused by uric acidcrystallization
To prevent urate nephropathy,serum uric acid must be reducedbefore chemotherapy
Rapid increase in serum uric acidcan result in acute uratenephropathy caused by uric acidcrystallization
To prevent urate nephropathy,serum uric acid must be reducedbefore chemotherapy
Clinical Implications--hyperuricemia– Gout (the amount of increase is not directly
related to the severity of the disease)– Renal diseases and renal failure, prerenal
azotemia– Alcoholism (ethanol consumption)– Down syndrome– Lead poisoning– Leukemia, multiple myeloma, lymphoma– Lesch-Nyhan syndrome (hereditary gout)– Starvation, weight-loss diets
– Gout (the amount of increase is not directlyrelated to the severity of the disease)
– Renal diseases and renal failure, prerenalazotemia
– Alcoholism (ethanol consumption)– Down syndrome– Lead poisoning– Leukemia, multiple myeloma, lymphoma– Lesch-Nyhan syndrome (hereditary gout)– Starvation, weight-loss diets
Clinical Implications--hyperuricemia–Metabolic acidosis, diabetic
ketoacidosis– Toxemia of pregnancy (serial
determination to follow therapy)– Liver disease– Hyperlipidemia, obesity– Hypoparathyroidism, hypothyroidism– Hemolytic anemia, sickle cell anemia
–Metabolic acidosis, diabeticketoacidosis
– Toxemia of pregnancy (serialdetermination to follow therapy)
– Liver disease– Hyperlipidemia, obesity– Hypoparathyroidism, hypothyroidism– Hemolytic anemia, sickle cell anemia
Clinical Implications--hyperuricemia–Following excessive cell destruction, asin chemotherapy and radiation treatment(acute elevation sometimes followstreatment)–Psoriasis–Glycogen storage disease (G6PDdeficiency)
–Following excessive cell destruction, asin chemotherapy and radiation treatment(acute elevation sometimes followstreatment)–Psoriasis–Glycogen storage disease (G6PDdeficiency)
Decreased levels of uric acid :
– Fanconi's syndrome–Wilson's disease– SIADH– Some malignancies (eg, Hodgkin's
disease, multiple myeloma)– Xanthinuria (deficiency of xanthine
oxidase)
– Fanconi's syndrome–Wilson's disease– SIADH– Some malignancies (eg, Hodgkin's
disease, multiple myeloma)– Xanthinuria (deficiency of xanthine
oxidase)
Clinical Findings
Acute kidney injuryHyperuremiaHyperphosphatemia (associated
symptoms include nausea,vomiting, seizures)
Hyperkalemia (can causearrhythmias and sudden death)
Acute kidney injuryHyperuremiaHyperphosphatemia (associated
symptoms include nausea,vomiting, seizures)
Hyperkalemia (can causearrhythmias and sudden death)
Diagnosis
Laboratory values should bemonitored following initiation ofchemotherapy
Elevated potassium or phosphoruslevels need to be promptlymanaged
Laboratory values should bemonitored following initiation ofchemotherapy
Elevated potassium or phosphoruslevels need to be promptlymanaged
Treatment
Prevention is most important The American Society of Clinical
Oncology guidelines recommendaggressive hydration before,during, and after chemotherapy tohelp keep urine flowing andfacilitate excretion of uric acid andphosphorus
Prevention is most important The American Society of Clinical
Oncology guidelines recommendaggressive hydration before,during, and after chemotherapy tohelp keep urine flowing andfacilitate excretion of uric acid andphosphorus
Allopurinol
Blocks the enzyme xanthineoxidase and therefore theformation of uric acid from purinebreakdown–
100 mg/m2 every 8 hours orally(maximum 800 mg/day) with doseadjustments for kidney diseaseshould be given before startingchemotherapy
Blocks the enzyme xanthineoxidase and therefore theformation of uric acid from purinebreakdown–
100 mg/m2 every 8 hours orally(maximum 800 mg/day) with doseadjustments for kidney diseaseshould be given before startingchemotherapy
Rasburicase
Indicated for patients at high riskfor developing tumor lysissyndrome or in whomhyperuricemia develops despitetreatment with allopurinol–
Indicated for patients at high riskfor developing tumor lysissyndrome or in whomhyperuricemia develops despitetreatment with allopurinol–
Rasburicase
Dosage: 0.1–0.2 mg/kg/dayintravenously for 1–7 days– Cannotbe given to patients with knownglucose 6-phosphatedehydrogenase (G6PD) deficiencynor can it be given to pregnant orlactating women
Dosage: 0.1–0.2 mg/kg/dayintravenously for 1–7 days– Cannotbe given to patients with knownglucose 6-phosphatedehydrogenase (G6PD) deficiencynor can it be given to pregnant orlactating women
Systemic bicarbonate infusions areno longer recommended