A 54-year-old man starting induction chemotherapy for Burkitt lymphoma develops AKI within 48 hours. Labs: potassium 6.6 mEq/L, phosphate 8.5 mg/dL, calcium 6.8 mg/dL, uric acid 16 mg/dL. He receives hydration and is started on a recombinant enzyme for urate lowering. Which drug was used?
- A Allopurinol
- B Febuxostat
- C Rasburicase ✓
- D Sodium bicarbonate infusion
Correct answer: C. Rasburicase
Explanation
Tumour lysis syndrome with established severe hyperuricaemia and AKI calls for rasburicase, a recombinant urate oxidase that converts uric acid to the soluble metabolite allantoin. Allopurinol and febuxostat only prevent new uric acid formation and do not lower existing urate, making them inadequate once severe hyperuricaemia with renal injury is present. Urinary alkalinisation is no longer recommended because it promotes calcium phosphate precipitation in alkaline urine.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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