PDF(Pubmed)
Abstract：
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 m2 (p = 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.
摘要：
心肾综合征（CRS）涉及心脏和肾脏的关节功能障碍。急性形式具有生化改变，例如高尿酸血症（HU）和肿瘤溶解综合征（TLS）。急性CRS伴全身超负荷的主要治疗方法是利尿剂，但是rasburicase在TLS中用于预防和治疗高尿酸血症。一个观察,进行回顾性研究以评估单剂量rasburicase在心肾综合征住院患者中的有效性和安全性。肾功能恶化，尿酸水平高于9mg/dL。Rasburicase改善了35例患者的利尿和全身充血。共有86%的患者不需要接受RRT，其余5人可以提前退出。用rasburicase治疗后，肌酐（Cr）从峰值3.6±1.27降至1.79±0.83mg/dL，估计的肾小球滤过率（eGFR）从17±8提高到41±20mL/min/1.73m2（p=0.0001）。N末端B型脑钠肽（Nt-ProBNP）和C反应蛋白（CRP）水平也明显降低。未发现相关不良事件。我们的结果表明，早期治疗与一定剂量的rasburicase在CRS和严重HU患者是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。
