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Abstract: FR-PO1082

Efficacy of Rasburicase in Children with AKI from Diarrhea-Associated Hemolytic Uremic Syndrome

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Ahn, Yo Han, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Cho, Myung hyun, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Lee, Jiwon M., Chungnam National University Children’s Hospital, Daejeon, Korea (the Republic of)
  • Ha, IL-Soo, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Cheong, Hae Il, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Kang, Hee Gyung, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
Background

Diarrhea associated hemolytic uremic syndrome (D+HUS) is a common etiology of acute kidney injury (AKI) in children. Hyperuricemia during acute phase is a typical finding of D+HUS. Recently we have used rasburicase to manage hyperuricemia, thereby ameliorate AKI and accelerate their recovery. Here we assessed the efficacy of rasburicase in D+HUS.

Methods

We retrospectively analyzed the medical records of pediatric D+HUS patients who were admitted to Seoul National University Children’s Hospital between January 2001 and July 2017. We compared the clinical outcomes between those treated with rasburicase (rasburicase group) and the rest (control group).

Results

A total of 72 patients were analyzed. Their median age was 3.2 years old. Median values of the lowest hemoglobin, the lowest platelet, and the highest uric acid were 6.3g/dL, 24,000/uL, and 12.6mg/dL, respectively. Twelve (16.7%) were treated with rasburicase. It was administered once at a median dose of 0.10 (range 0.05–0.20) mg/kg during the first day of admission. There was no difference in age, sex, the lowest hemoglobin, the lowest estimated glomerular filtration rate (eGFR), and the highest uric acid between the rasburicase group and the control group. The lowest platelet in rasburicase group was lower than that in the control group (14,000 vs. 25,000/uL; P=0.002). In the rasburicase group, hyperuricemia was rapidly reversed (2.4 vs. 6.5 days; P<0.001). There was no statistical difference in requirement of dialysis (66.7% vs. 55.0%; P= 0.456) and the duration of dialysis (5.5 vs. 8.6 days; P=0.262) between the two groups. However, median hospital length of stay was shorter in the rasburicase group than in the control group (12.9 vs. 18.2 days; P=0.043), and median eGFR at 1 year follow up was lower in the control group than in the rasburicase group (81.2 vs. 111.0 mL/min/1.73m2, P=0.002).

Conclusion

Although rasburicase treatment in patients with D+HUS did not lower the requirement of dialysis, patients who were treated with rasburicase during the acute phase were discharged earlier from the hospital and had better renal function at 1 year follow-up. Since there are no known effective therapies for AKI induced by D+HUS, we may consider rasburicase to improve their long-term renal outcome.