RESUMO
AIMS: Hyperuricemia is a risk factor associated with cardiovascular and renal disease. Recently, rasburicase, a recombinant urate oxidase, has been developed for the treatment of hyperuricemia in patients with primarily hematological malignancies. We studied the pharmacokinetics and metabolism of rasburicase in the treatment of chronic asymptomatic hyperuricemia in chronic kidney disease (CKD) patients. MATERIALS AND METHODS: We studied 9 CKD patients with hyperuricemia, whose mean serum acid concentration was 10.2 (range 8.3-15.8) mg/dl. No study subject was taking allopurinol (3/9 are allopurinol intolerant). Patients were treated with rasburicase (0.2 mg/kg/day) in single dose by intravenous infusion over a 30-min period. Serum samples were collected after 1, 4, 8, 24, 48 and 72 h, after 1 week, and after 1 month. To evaluate the efficacy of rasburicase, plasma and urinary concentrations of uric acid were determined by the standard method; the plasma activity of rasburicase was determined using a new assay developed by our laboratory (chromatography-mass method, a colorimetric 96-well microtiter plate assay). RESULTS: All the treated patients experienced a rapid reduction in their plasma uric acid concentration. Data showed an undetectable value within 1 h of treatment. The rasburicase effect ended after 50 h, with a slow increase in the plasma level of uric acid. CONCLUSION: A single dose of rasburicase is highly effective and well tolerated in the treatment of hyperuricemia in selected CKD patients.
Assuntos
Hiperuricemia/tratamento farmacológico , Falência Renal Crônica/complicações , Urato Oxidase/administração & dosagem , Ácido Úrico/sangue , Adulto , Idoso , Feminino , Humanos , Hiperuricemia/etiologia , Infusões Intravenosas , Falência Renal Crônica/metabolismo , Testes de Função Renal , Medições Luminescentes/métodos , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/farmacocinética , Urato Oxidase/farmacocinética , Ácido Úrico/metabolismo , Ácido Úrico/urinaRESUMO
BACKGROUND: The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than that expected in age and sex-matched controls from the general population, and there is a markedly increased incidence of certain cancers. METHODS: In 1137 renal transplant recipients (1020 from cadaveric and 117 from living donors, M/F 771/366) performed at the S. Orsola Renal Transplantation Centre since 10/1976 to 9/2001, we studied the post-transplant cancer prevalence, the correlation between cancer prevalence and population characteristics, the risk factors (smoke, cancer history, positive HBsAg and antiHCV infection) and the immunosuppressive therapy. RESULTS AND CONCLUSIONS: The prevalence of malignancies was 3.86% (52 malignancies in 44 patients). The period between transplant and diagnosis of malignant disease was 59 +/- 85 months. Skin cancer was the most common (n=16; 30.7%), followed by lymphoproliferative disorders (n=8; 15.4%), Kaposi s sarcoma (n=6; 11.5%), uterine cancer (n=6; 11.5%), renal carcinoma of native kidney (n=5; 9.6%), cancer of breast/stomach/pancreas and urinary bladder (n=2; 3.8%) and other cancers (n=5; 9.6%). The mean duration of dialysis before transplantation was longer in cancer patients (41+/- 32.1 vs. 33.5 +/- 32.4 months). We found a correlation between types of malignancies and viral infection in NH-lymphoma (EBV positive 4/4) and skin cancer (HZV positive 13/16). We also detected a correlation between Aza and skin cancer (16/22) and CyA and lymphoproliferative disorders (7/8).
Assuntos
Transplante de Rim , Neoplasias/epidemiologia , Adulto , Feminino , Humanos , Masculino , Prevalência , Estudos RetrospectivosAssuntos
Anticoagulantes/uso terapêutico , Materiais Biocompatíveis , Coagulação Sanguínea/efeitos dos fármacos , Heparina/uso terapêutico , Falência Renal Crônica/sangue , Membranas Artificiais , Ativação Plaquetária , Polimetil Metacrilato , Diálise Renal/instrumentação , Idoso , Anticoagulantes/farmacologia , Materiais Biocompatíveis/química , Plaquetas/metabolismo , Tamanho Celular , Feminino , Heparina/farmacologia , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Fator Plaquetário 4/análise , Fator Plaquetário 4/metabolismo , Polimetil Metacrilato/química , Diálise Renal/efeitos adversos , Serotonina/sangue , Serotonina/metabolismo , Trombose/prevenção & controle , beta-Tromboglobulina/análiseRESUMO
This paper reports on 3 patients on renal dialysis for crescentic glomerulonephritis associated with microscopic polyarteritis (MPA) and antineutrophil cytoplasmic autoantibodies specific for myeloperoxidase (MPO-ANCAs). They successfully underwent renal transplantation from a cadaver donor 6-63 months after the onset of the disease, despite the persistence of antibodies at high titer. A triple immunosuppressive regimen including steroids, cyclosporin and azathioprine was used. One patient underwent transplantectomy for surgical complications 3 months later, while the serum creatinine was 2.0 mg/dl (178 mu mol/l): the remainder have a well-functioning graft after 21 and 38 months, no clinical sign of disease recurrence, and a MPO titer within the normal range. We conclude that MPA patients can undergo renal transplantation even if ANCAs persist at a high titer in the circulation.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Glomerulonefrite/cirurgia , Transplante de Rim , Peroxidase/imunologia , Poliarterite Nodosa/cirurgia , Adolescente , Adulto , Creatinina/sangue , Feminino , Glomerulonefrite/etiologia , Glomerulonefrite/imunologia , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/etiologia , Masculino , Poliarterite Nodosa/complicações , Poliarterite Nodosa/imunologia , Diálise RenalRESUMO
A sudden-onset chyluria after trauma was evaluated giving evidence of a lymphatic-urinary fistula in the right kidney. Treatment with somatostatin normalized the urinary pattern and the result was maintained even after the discontinuation of the therapy.