rasburicase Howard et al. 2011
. Continuous arteriovenous and venovenous hemofi ltration,
continuous venovenous hemodialysis, and con- tinuous venovenous hemodiafi ltration have all
been found safe and effective in CTLS Bishof et al.
1990 ; Heney et al.
1990 ; Sakarcan and
Quigley 1994
; Saccente et al. 1995
; Howard et al. 2011
. Long-term renal function in pediatric patients who suffer from TLS has been reported
to be normal Stapleton et al. 1988
.
3.6 Summary
TLS risk factor stratifi cation is vital for determin- ing which preventative measures are appropriate
for each individual patient. Although guidelines exist, the risk stratifi cation provided is based on
consensus statements and adult data and does not extrapolate to all pediatric oncology populations.
Subsequently such stratifi cation may lead to increased utilization of expensive medications
such as rasburicase in situations where it is not justifi ed based on the existing evidence. Although
urinary alkalinization may not be recommended in some guidelines, it may still be benefi cial in
situations where the uric acid level is not high enough to justify rasburicase. The practitioner
should be aware of true high-risk scenarios in which rasburicase should be utilized and the
patient monitored extremely carefully for meta- bolic complications related to hyperkalemia,
hypocalcemia and AKI secondary to calcium phosphate precipitation. Early consultation with
nephrology and intensive care should be consid- ered in such high-risk situations.
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