The physician treating the 9-year-old girl in Question 5 is surprised that a medication was not administered to this patient prior to the initiation of chemotherapy to prevent tumor lysis syndrome.
Which of the following medications might have prevented this patient’s renal failure?
A. KayexalateAllopurinol. Tumor lysis syndrome can result in acute urate nephropathy causing acute renal failure. Allopurinol has been shown to reduce the likelihood of acute urate nephropathy. Allopurinol is a purine analog that inhibits the enzyme xanthine oxidase, which prevents the production of uric acid. In addition to its use in preventing complications of tumor lysis syndrome, allopurinol is used in the treatment of chronic gout (of note, it does not treat acute gout attacks; rather it prevents attacks). Urate oxidase therapy is largely replacing allopurinol in reducing tumor lysis syndrome complications. (A, B, D) These treatments are all effective in the treatment of hyperkalemia as they all cause an intracellular potassium shift. However, even though hyperkalemia is seen in tumor lysis syndrome, these medications will have no efficacy in lowering uric acid levels and therefore not prevent acute renal failure. In other words, these medications treat the complication (hyperkalemia); they do not prevent renal failure.