A 12-year-old boy with newly diagnosed Burkitt lymphoma (bulky abdominal disease, LDH 1800 U/L) is to start chemotherapy. Pre-treatment uric acid is 13.5 mg/dL with creatinine 1.4 mg/dL. Which agent is most appropriate to rapidly reduce the existing uric acid load and prevent urate nephropathy?
- A Allopurinol
- B Febuxostat
- C Rasburicase ✓
- D Probenecid
Correct answer: C. Rasburicase
Explanation
Rasburicase is recombinant urate oxidase, which converts existing uric acid to the far more soluble allantoin, so it actively lowers an already elevated level and is preferred in tumour lysis syndrome with high baseline urate or renal impairment. Allopurinol only blocks xanthine oxidase and prevents new urate formation, so it cannot clear uric acid already present. Probenecid is contraindicated here because uricosuric agents worsen intratubular crystal deposition.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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