A 34-year-old man with bulky stage III Burkitt lymphoma starts induction chemotherapy. Twelve hours later he develops oliguria, serum uric acid 19 mg/dL, phosphate 9.2 mg/dL, potassium 6.9 mEq/L, and calcium 6.0 mg/dL. Creatinine rises to 3.4 mg/dL. Along with aggressive hydration, which agent is most appropriate for the hyperuricaemia?

• A Allopurinol
• B Febuxostat
• C Probenecid
• D Rasburicase ✓

Explanation

Tumour lysis syndrome with severe hyperuricaemia and established AKI calls for rasburicase, a recombinant urate oxidase that converts existing uric acid to the soluble metabolite allantoin, rapidly lowering urate. Allopurinol and febuxostat only block new xanthine formation and are too slow once urate has already crystallised in tubules. Probenecid promotes urate excretion but worsens tubular urate load and is contraindicated here.

Reference: Williams Hematology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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