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Hammami MB, Qasim A, Thakur R, Vegivinti CTR, Patton CD, Vikash S, Kumar A. Rasburicase-induced hemolytic anemia and methemoglobinemia: a systematic review of current reports. Ann Hematol 2024; 103:3399-3411. [PMID: 37468669 DOI: 10.1007/s00277-023-05364-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
Since the FDA's approval of rasburicase use for treatment of tumor lysis syndrome (TLS), multiple cases of rasburicase-induced methemoglobinemia and hemolytic anemia have been reported among patients with G6PD deficiency. This study aims to provide a systematic review of cases reporting such adverse reactions to rasburicase. A literature review of published cases in PubMed, Embase, Cochrane, and Web of Science was conducted. Descriptive studies reporting cases of rasburicase-induced methemoglobinemia and/or hemolytic anemia in English were analyzed and summarized in this study. Forty-three cases, including a case from our institution, were included in this study. Most cases (60.5%) received rasburicase for TLS treatment. Almost all patients (93.8%) were tested for G6PD after rasburicase administration. The median time to symptom onset was 24 h. The median methemoglobin level was 10%, peaking after a median of 24 h. The median hemoglobin nadir was 6.1 g/dL, and most patients (n = 32) required blood transfusion. Out of 39 cases with reported outcomes, 35 patients (89.7%) recovered, while four patients (three females and one male) died. The median time to recovery was 4.5 days while the median time to death was 8 days. Screening for G6PD deficiency among high-risk patients is important but not practical in acutely severe settings. When prior screening for G6PD deficiency is not feasible, close monitoring for methemoglobinemia and hemolytic anemia is recommended. Exchange transfusion is increasingly reported as a potentially successful therapeutic modality. Ascorbic acid may provide limited benefits. Methylene blue should be avoided as it may exacerbate hemolysis among these patients.
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Affiliation(s)
- M Bakri Hammami
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Asma Qasim
- Department of Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Rahul Thakur
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Charan Thej Reddy Vegivinti
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA
- Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sindhu Vikash
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Abhishek Kumar
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA
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Latcha S, Shah CV. Rescue Therapies for AKI in Onconephrology: Rasburicase and Glucarpidase. Semin Nephrol 2023; 42:151342. [PMID: 37167817 DOI: 10.1016/j.semnephrol.2023.151342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Tumor lysis syndrome (TLS) and high-dose methotrexate (HD MTX) toxicity can present with potentially severe complications, including acute kidney injury, in patients with malignancy. Guidelines for using rasburicase and glucarpidase as rescue therapies for TLS and HD MTX toxicity, respectively, are widely used by clinicians intending to mitigate organ toxicity and decrease morbidity and mortality as a consequence of cancer therapy. This review discusses the pathogenesis of TLS and HD MTX-associated toxicity, to understand the mechanism of action of these therapeutic agents and to review the currently available evidence supporting their use.
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Affiliation(s)
- Sheron Latcha
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Chintan V Shah
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL
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Habas E, Akbar R, Farfar K, Arrayes N, Habas A, Rayani A, Alfitori G, Habas E, Magassabi Y, Ghazouani H, Aladab A, Elzouki AN. Malignancy diseases and kidneys: A nephrologist prospect and updated review. Medicine (Baltimore) 2023; 102:e33505. [PMID: 37058030 PMCID: PMC10101313 DOI: 10.1097/md.0000000000033505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
Acute kidney injury (AKI), chronic renal failure, and tubular abnormalities represent the kidney disease spectrum of malignancy. Prompt diagnosis and treatment may prevent or reverse these complications. The pathogenesis of AKI in cancer is multifactorial. AKI affects outcomes in cancer, oncological therapy withdrawal, increased hospitalization rate, and hospital stay. Renal function derangement can be recovered with early detection and targeted therapy of cancers. Identifying patients at higher risk of renal damage and implementing preventive measures without sacrificing the benefits of oncological therapy improve survival. Multidisciplinary approaches, such as relieving obstruction, hydration, etc., are required to minimize the kidney injury rate. Different keywords, texts, and phrases were used to search Google, EMBASE, PubMed, Scopus, and Google Scholar for related original and review articles that serve the article's aim well. In this nonsystematic article, we aimed to review the published data on cancer-associated kidney complications, their pathogenesis, management, prevention, and the latest updates. Kidney involvement in cancer occurs due to tumor therapy, direct kidney invasion by tumor, or tumor complications. Early diagnosis and therapy improve the survival rate. Pathogenesis of cancer-related kidney involvement is different and complicated. Clinicians' awareness of all the potential causes of cancer-related complications is essential, and a kidney biopsy should be conducted to confirm the kidney pathologies. Chronic kidney disease is a known complication in malignancy and therapies. Hence, avoiding nephrotoxic drugs, dose standardization, and early cancer detection are mandatory measures to prevent renal involvement.
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Affiliation(s)
- Elmukhtar Habas
- Facharzt Internal Medicine, Facharzt Nephrology, Medical Department, Hamad General Hospital, Doha, Qatar
| | - Raza Akbar
- Medical Department, Hamad General Hospital, Doha, Qatar
| | - Kalifa Farfar
- Facharzt Internal Medicine, Medical Department, Alwakra General Hospital, Alwakra, Qatar
| | - Nada Arrayes
- Medical Education Fellow, Lincoln Medical School, University of Lincoln, Lincoln, UK
| | - Aml Habas
- Hematology-Oncology Department, Tripoli Children Hospital, Tripoli, Libya
| | - Amnna Rayani
- Facharzt Pediatric, Facharzt Hemotoncology, Hematology-Oncology Department, Tripoli Children Hospital, Tripoli, Libya
| | | | - Eshrak Habas
- Medical Department, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
| | | | - Hafidh Ghazouani
- Quality Department, Senior Epidemiologist, Hamad Medical Corporation, Doha, Qatar
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Yu R, Chen CR, Evans D, Qing X, Gotesman M, Chandramohan G, Kallay T, Lin HJ, Pedigo TP. Glucose-6-phosphate dehydrogenase deficiency presenting with rhabdomyolysis in a patient with coronavirus disease 2019 pneumonia: a case report. J Med Case Rep 2022; 16:106. [PMID: 35287717 PMCID: PMC8919902 DOI: 10.1186/s13256-022-03322-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 01/04/2023] Open
Abstract
Background Glucose-6-phosphate dehydrogenase deficiency is a rarely recognized predisposing factor for rhabdomyolysis. Rhabdomyolysis with coronavirus disease 2019 has been increasingly seen during the pandemic. We report the uncommon occurrence of coronavirus disease 2019 pneumonia, severe rhabdomyolysis, and acute renal failure in the setting of glucose-6-phosphate dehydrogenase deficiency. Case presentation A 19-year-old African American male presented with myalgias, diaphoresis, and dark urine. Testing for severe acute respiratory syndrome coronavirus 2 was positive. He had severe rhabdomyolysis with creatine kinase levels up to 346,695 U/L. He was oliguric and eventually required hemodialysis. Progressive hypoxemia, methemoglobinemia, and hemolytic anemia occurred following one dose of rasburicase for hyperuricemia. Glucose-6-phosphate dehydrogenase deficiency was diagnosed. Full recovery followed a single volume exchange transfusion and simple packed red blood cell transfusions. Conclusions Glucose-6-phosphate dehydrogenase deficiency may predispose individuals to rhabdomyolysis due to severe acute respiratory syndrome coronavirus 2, presumably due to altered host responses to viral oxidative stress. Early screening for glucose-6-phosphate dehydrogenase deficiency can be useful for management of patients with rhabdomyolysis.
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Affiliation(s)
- Regina Yu
- Division of Pediatric Critical Care, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson St, Building N-25, Box 491, Torrance, CA, 90502, USA
| | - Chien-Rong Chen
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Darci Evans
- Division of Pediatric Critical Care, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson St, Building N-25, Box 491, Torrance, CA, 90502, USA
| | - Xin Qing
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Moran Gotesman
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Gangadarshni Chandramohan
- Division of Pediatric Nephrology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Thomas Kallay
- Division of Pediatric Critical Care, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson St, Building N-25, Box 491, Torrance, CA, 90502, USA
| | - Henry J Lin
- Division of Medical Genetics, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tiffany P Pedigo
- Division of Pediatric Critical Care, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson St, Building N-25, Box 491, Torrance, CA, 90502, USA.
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Abramson M, Mehdi A. Hematological Malignancies and the Kidney. Adv Chronic Kidney Dis 2022; 29:127-140.e1. [PMID: 35817520 DOI: 10.1053/j.ackd.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
The incidence of hematologic malignancies is on the rise worldwide. Kidney disease is ubiquitous in patients with hematologic malignancies, encompassing a wide spectrum of disorders involving each kidney compartment, including the vasculature, tubules, interstitium, and glomerulus, and there is significant overlap of kidney involvement with each hematologic malignancy. Vascular disorders include both microvascular and macrovascular damage, via thrombotic microangiopathy, hyperleukocytosis, hyperviscosity, and cryoglobulinemia. The tubulointerstitial compartment may be affected by prerenal azotemia and acute tubular injury, but malignant infiltration, tumor lysis syndrome, extramedullary hematopoiesis, cast nephropathy, granulomatous interstitial nephritis, and lysozymuria should be considered in certain populations. Obstructive uropathy may occur due to nephrolithiasis or retroperitoneal fibrosis. Glomerular disorders, including membranoproliferative, membranous, minimal change, and focal segmental glomerulosclerosis, can rarely occur. By understanding how each compartment may be affected, care can best be optimized for these patients. In this review, we summarize the widely varied etiologies of kidney diseases stratified by kidney compartment and hematologic malignancy, focusing on demographics, pathology, pathophysiology, mechanism, and outcomes. We conclude with common electrolyte abnormalities associated with hematologic malignancies.
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Vidhyashree BH, Zuber M, Taj S, Venkataraman R, Sathish Kumar BP, Jabeen N. Rasburicase induced methemoglobinemia: A systematic review of descriptive studies. J Oncol Pharm Pract 2022:10781552221075239. [PMID: 35119341 DOI: 10.1177/10781552221075239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE There is an increased number of reports being published on rasburicase-induced methemoglobinemia recently. We aimed to identify and critically evaluate all the descriptive studies that described the rasburicase-induced methemoglobinemia, its treatment approach, and their outcomes. METHODOLOGY PubMed, Scopus and grey literature databases were searched from inception to January 2022 using search terms "rasburicase" and "methemoglobinemia" without any language and date restriction. A bibliographic search was also done to find additional studies. Only descriptive studies on Rasburicase-induced methemoglobinemia were included for our review. Two contributors worked independently on study selection, data abstraction, and quality assessment, and any disagreements were resolved by consensus or discussion with a third reviewer. RESULT A total of 24 reports including 27 patients (23 male, 3 female patients, and 1 study did not specify the gender of the patient) aged from 5 to 75 years were included in the review. Immediate withdrawal of the drug and administering methylene blue, ascorbic acid, blood transfusion, and supportive oxygen therapy are the cornerstone in the management of rasburicase-induced methemoglobinemia. CONCLUSION Rasburicase administration should be followed by careful monitoring of patients for any severe complication and treat it as early as possible appropriately. In a patient who presents with rasburicase-induced haemolysis or methemoglobinemia, it is often important to expect a diagnosis of G6PD deficiency unless otherwise confirmed and to avoid administering methylene blue, even though the patient is from a low-risk ethnicity for G6PDD.
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Affiliation(s)
- B H Vidhyashree
- Department of Pharmacy Practice, 75972Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka, India
| | - Mohammed Zuber
- Department of Pharmacy Practice, 75972Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka, India
| | - Shifa Taj
- Department of Pharmacy Practice, 77379Sarada Vilas College of Pharmacy, Mysore, Karnataka, India
| | - Rajesh Venkataraman
- Department of Pharmacy Practice, 75972Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka, India
| | - B P Sathish Kumar
- Department of Pharmacy Practice, 75972Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka, India
| | - Nihala Jabeen
- Markaz Unani Medical College and Hospital, Markaz Knowledge City, Kaithapoyil, Thamarassery, Kerala, India
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Braet P, Sartò GVR, Pirovano M, Sprangers B, Cosmai L. Treatment of Acute Kidney Injury in Cancer Patients. Clin Kidney J 2021; 15:873-884. [PMID: 35498895 PMCID: PMC9050558 DOI: 10.1093/ckj/sfab292] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
Acute kidney injury (AKI), either of pre-renal, renal or post-renal origin, is an important complication in cancer patients, resulting in worse prognosis, withdrawal from effective oncological treatments, longer hospitalizations and increased costs. The aim of this article is to provide a literature review of general and cause-specific treatment strategies for AKI, providing a helpful guide for clinical practice. We propose to classify AKI as patient-related, cancer-related and treatment-related in order to optimize therapeutic interventions. In the setting of patient-related causes, proper assessment of hydration status and avoidance of concomitant nephrotoxic medications is key. Cancer-related causes mainly encompass urinary compression/obstruction, direct tumoural kidney involvement and cancer-induced hypercalcaemia. Rapid recognition and specific treatment can potentially restore renal function. Finally, a pre-treatment comprehensive evaluation of risks and benefits of each treatment should always be performed to identify patients at high risk of treatment-related renal damage and allow the implementation of preventive measures without losing the potentialities of the oncological treatment. Considering the complexity of this field, a multidisciplinary approach is necessary with the goal of reducing the incidence of AKI in cancer patients and improving patient outcomes. The overriding research goal in this area is to gather higher quality data from international collaborative studies.
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Affiliation(s)
- Pauline Braet
- Division of Nephrology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Giulia Vanessa Re Sartò
- Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Marta Pirovano
- Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Ben Sprangers
- Division of Nephrology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Laura Cosmai
- Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
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8
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Acute kidney injury in cancer patients. Clin Exp Nephrol 2021; 26:103-112. [PMID: 34499266 DOI: 10.1007/s10157-021-02131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We want to know the causes of AKI in oncology patients, including disease-related complications and the nephrotoxicity of chemotherapy drugs, in order to provide more useful clinical information. METHODS In this review, an electronic search of the English language literature was performed in the database PubMed, with the results enriched by manual searches and citation mining, factors investigated in the selected articles included acute kidney injury, oncology, chemotherapy, anticancer drug, antitumor drug. RESULTS According to the searched articles, we summarized the causes (including pre-renal, intrinsic renal, and post-renal lesion) of AKI in cancer patients and the corresponding management measures. Among the pre-renal factors we mainly described hypercalcemia, hematopoietic cell transplantation, post-renal factors we mainly described hemorrhagic cystitis, and intrinsic renal factors we mainly described thrombotic microangiopathy, chemotherapeutics, tumor lysis syndrome, cast nephropathy, in which the emphasis was on chemotherapy drug associated AKI and its treatment. CONCLUSIONS AKI is not uncommon in cancer patients, and has diverse causes and negative outcomes. Both nephrologists and oncologists need to be aware of the unique reasons of AKI in this population and its optimal management.
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Ahmed M, Sanchez T, Norgbe S, Picking CR, Millner PG. Rasburicase-Induced Methemoglobinemia. Cureus 2021; 13:e14406. [PMID: 33987056 PMCID: PMC8110197 DOI: 10.7759/cureus.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Methemoglobinemia occurs as iron in heme is oxidized to its ferric state, resulting in a decreased ability of hemoglobin to bind and release oxygen. Rasburicase is a recombinant urate-oxidase enzyme used in the prevention of tumor lysis syndrome. Methemoglobinemia can occur as a rare complication of treatment with rasburicase, primarily in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Methylene blue, an agent used for treating methemoglobinemia, should be avoided in patients with G6PD deficiency. In patients with G6PD deficiency, methylene blue is inadequately reduced to its active form, which then causes the methylene blue to further the oxidize the hemoglobin to methemoglobin that can result in hemolysis.
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Affiliation(s)
- Moeed Ahmed
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Thomas Sanchez
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Selinam Norgbe
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | | | - Paul G Millner
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
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Singh P, Rakesh K, Agarwal R, Tripathi PP, Dhooria S, Sehgal IS, Prasad KT, Hans R, Sharma R, Sharma N, Lad D, Aggarwal AN, Muthu V. Therapeutic whole blood exchange in the management of methaemoglobinemia: Case series and systematic review of literature. Transfus Med 2020; 30:231-239. [DOI: 10.1111/tme.12666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Pawan Singh
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Kodati Rakesh
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Ritesh Agarwal
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Paramatma P. Tripathi
- Department of Transfusion medicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Sahajal Dhooria
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Inderpaul S. Sehgal
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Kuruswamy T. Prasad
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Rekha Hans
- Department of Transfusion medicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Rattiram Sharma
- Department of Transfusion medicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Navneet Sharma
- Department of Internal MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Deepesh Lad
- Department of HematologyPostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Ashutosh N. Aggarwal
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Valliappan Muthu
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
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Rosner MH, Perazella MA. Acute kidney injury in the patient with cancer. Kidney Res Clin Pract 2019; 38:295-308. [PMID: 31284363 PMCID: PMC6727896 DOI: 10.23876/j.krcp.19.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/05/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
Dramatic advances in the care of patients with cancer have led to significant improvement in outcomes and survival. However, renal manifestations of the underlying cancer as well as the effects of anti-neoplastic therapies leave patients with significant morbidity and chronic kidney disease risks. The most common renal manifestations associated with cancer include acute kidney injury (AKI) in the setting of multiple myeloma, tumor lysis syndrome, post-hematopoietic stem cell therapy, and AKI associated with chemotherapy. Knowledge of specific risk factors, modification of risk and careful attention to rapid AKI diagnosis are critical for improving outcomes.
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Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA
| | - Mark A Perazella
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
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13
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周 燕, 胡 韦, 张 虹, 邹 琳, 张 鹏. [Establishment of a stable HEK293T cell line with c.392G>T (p.131G>V) mutation site knockout in G6PD gene using CRISPR/Cas9 technique]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:320-327. [PMID: 31068316 PMCID: PMC6765671 DOI: 10.12122/j.issn.1673-4254.2019.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To establish a stable HEK293T cell line with c.392G>T (p.131G>V) mutation site knockout in G6PD gene using CRISPR/Cas9 technique. METHODS We designed 4 pairs of small guide RNA (sgRNA) for G6PD c.392G>T(p.131G>V) mutation site, and constructed exogenous PX458 plasmids expressing Cas9-sgRNA. The plasmids were transfected into HEK293T cells, and the cells expressing GFP fluorescent protein were separated by flow cytometry for further culture. After verification of the knockout efficiency using T7 endonuclease Ⅰ, the monoclonal cells were screened by limiting dilution and DNA sequencing to confirm the knockout. We detected the expressions of G6PD mRNA and protein and examined functional changes of the genetically modified cells. RESULTS We successfully constructed the Cas9-sgRNA exogenous PX458 plasmid based on the c.392G>T(p.131G>V) mutation site of G6PD gene. The editing efficiency of the 4 pairs of sgRNA, as detected by T7E1 enzyme digestion, was 6.74%, 12.36%, 12.54% and 2.94%. Sanger sequencing confirmed that the HEK293T cell line with stable knockout of G6PD c.392G>T(p.131G>V) was successfully constructed. The genetically modified cells expressed lower levels of G6PD mRNA and G6PD protein and showed reduced G6PD enzyme activity and proliferative capacity and increased apoptosis in response to vitamin K3 treatment. CONCLUSIONS We successfully constructed a stable HEK293T cell model with G6PD gene c.392G>T(p.131G>V) mutation site knockout to facilitate future study of gene repair.
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Affiliation(s)
- 燕霞 周
- />重庆医科大学附属儿童医院临检中心//儿童发育疾病教育部重点实验室//儿童发育重大疾病国家国际科技合 作基地//认知发育与学习记忆障碍转化医学重庆市重点实验室, 重庆 400014Center for Clinical Examination, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400014, China
| | - 韦维 胡
- />重庆医科大学附属儿童医院临检中心//儿童发育疾病教育部重点实验室//儿童发育重大疾病国家国际科技合 作基地//认知发育与学习记忆障碍转化医学重庆市重点实验室, 重庆 400014Center for Clinical Examination, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400014, China
| | - 虹洋 张
- />重庆医科大学附属儿童医院临检中心//儿童发育疾病教育部重点实验室//儿童发育重大疾病国家国际科技合 作基地//认知发育与学习记忆障碍转化医学重庆市重点实验室, 重庆 400014Center for Clinical Examination, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400014, China
| | - 琳 邹
- />重庆医科大学附属儿童医院临检中心//儿童发育疾病教育部重点实验室//儿童发育重大疾病国家国际科技合 作基地//认知发育与学习记忆障碍转化医学重庆市重点实验室, 重庆 400014Center for Clinical Examination, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400014, China
| | - 鹏辉 张
- />重庆医科大学附属儿童医院临检中心//儿童发育疾病教育部重点实验室//儿童发育重大疾病国家国际科技合 作基地//认知发育与学习记忆障碍转化医学重庆市重点实验室, 重庆 400014Center for Clinical Examination, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400014, China
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Raru Y, Abouzid M, Parsons J, Zeid F. Rasburicase induced severe hemolysis and methemoglobinemia in a Caucasian patient complicated by acute renal failure and ARDS. Respir Med Case Rep 2018; 26:142-145. [PMID: 30603605 PMCID: PMC6307101 DOI: 10.1016/j.rmcr.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022] Open
Abstract
Rasburicase is a recombinant urate-oxidase enzyme and is a very important medication for tumor lysis syndrome. Methemoglobinemia and hemolysis are known side effects of rasburicase that result from oxidative stress caused by hydrogen peroxide, a byproduct generated during the breakdown of uric acid to allantoin. Patients with G6PD deficiency have a decreased tolerance to oxidative stress and are therefore at a greater risk of hemolysis and methemoglobinemia with rasburicase. Our patient is a 56-year-old Caucasian male with a recent diagnosis of grade 2-3a non-Hodgkin's lymphoma who presented to our emergency department with shortness of breath and dark discoloration of urine. Patient was discharged 36 hours ago from our hospital after he was given a first course of R-CHOP regimen and a dose of rasburicase. On further evaluation, patient was found to have severe anemia with hemolytic picture, hyperkalemia and acute kidney injury. He also had a discrepancy of the transcutaneous saturation (75%) and the saturation in an arterial blood gas value (99%). His methemoglobin level was found to be 11.9%. We were aware that methylene blue is a contraindication in patients with G6PD deficiency but considering patient being Caucasian and low risk for it and his deteriorating respiratory condition, it was decided to offer the treatment and patient received 1 dose of methylene blue which failed to improve his methemoglobinemia. He was also given vitamin C and 8 units of packed red blood cell throughout his stay in the hospital. Patient's hospital course was complicated by ARDS needed to be on mechanical ventilation support for 4 days and acute renal failure secondary to pigment nephropathy and acute tubular necrosis which required a hemodialysis support. Even if rasburicase induced methemoglobinemia and hemolysis are not very common complications, clinicians who prescribe and follow patients should detect this serious complication early and manage it accordingly. Our case can be used as a reminder that patients should be followed closely and given the right instructions on discharge to treat these complications which are associated with severe consequences. It is also vital to assume a diagnosis of G6PD deficiency until proven otherwise in a patient who presents with rasburicase induced hemolysis and avoid administration of methylene blue even if the patient is from a low risk ethnicity for G6PD as in our patient.
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Affiliation(s)
- Yonas Raru
- Internal Medicine Resident, Marshall University School of Medicine, Huntington, WV, USA
- Corresponding author.
| | - Mahmoud Abouzid
- Internal Medicine Resident, Marshall University School of Medicine, Huntington, WV, USA
| | - Julia Parsons
- Internal Medicine Resident, Marshall University School of Medicine, Huntington, WV, USA
| | - Fuad Zeid
- Pulmonary and Critical Care Medicine, Marshall University School of Medicine, Huntington, WV, USA
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Belfield KD, Tichy EM. Review and drug therapy implications of glucose-6-phosphate dehydrogenase deficiency. Am J Health Syst Pharm 2018; 75:97-104. [PMID: 29305344 DOI: 10.2146/ajhp160961] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The pathophysiology, diagnosis, and medication-use implications of glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzyme deficiency in humans, are reviewed. SUMMARY Originally identified as favism in patients who experienced hemolysis after ingestion of fava beans, G6PD deficiency results from an X-linked chromosomal mutation that leads to reduced activity of the enzyme responsible for the final step of the pentose phosphate pathway, through which reduced nicotinamide adenine dinucleotide phosphate required for protection of cells from oxidative stress is produced. G6PD deficiency affects about 400 million people worldwide. Diagnosis of G6PD can be made through detection of enzymatic activity (by spectrophotometric testing, fluorescence testing, or formazan-based spot testing) or molecular analysis to detect known mutations of the gene encoding G6PD. Most individuals with G6PD deficiency are asymptomatic throughout life. Symptoms of acute hemolysis associated with G6PD deficiency include anemia, fatigue, back or abdominal pain, jaundice, and hemoglobinuria. The most common precipitators of oxidative stress and hemolysis in G6PD deficiency include medication use and infection. CONCLUSION G6PD deficiency should be considered in patients who experience acute hemolysis after exposure to known oxidative medications, infection, or ingestion of fava beans. A diagnosis of G6PD deficiency is most often made through enzymatic activity detection, but molecular analysis may be required in females heterozygous for the disorder. When clinically feasible, rasburicase, primaquine, dapsone, pegloticase, and methylene blue should not be used until a G6PD diagnostic test has been performed.
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Affiliation(s)
- Mitchell H Rosner
- From the Division of Nephrology, University of Virginia Health System, Charlottesville (M.H.R.); and the Section of Nephrology, Yale University School of Medicine, New Haven, and the Veterans Affairs Medical Center, West Haven - both in Connecticut (M.A.P.)
| | - Mark A Perazella
- From the Division of Nephrology, University of Virginia Health System, Charlottesville (M.H.R.); and the Section of Nephrology, Yale University School of Medicine, New Haven, and the Veterans Affairs Medical Center, West Haven - both in Connecticut (M.A.P.)
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Ibrahim U, Saqib A, Mohammad F, Atallah JP, Odaimi M. Rasburicase-induced methemoglobinemia: The eyes do not see what the mind does not know. J Oncol Pharm Pract 2017; 24:309-313. [PMID: 28345492 DOI: 10.1177/1078155217701295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rasburicase is indicated for the prevention and treatment of tumor lysis syndrome which can be a potentially life-threatening emergency. The drug has oxidizing potential and as an adverse effect, it can convert the ferrous form of iron in erythrocytes to its ferric form resulting in the formation of methemoglobin which makes the heme component incapable of carrying oxygen. Patients with glucose-6-phosphate dehydrogenase enzyme deficiency are at high risk of methemoglobinemia from oxidizing agents. Symptoms of methemoglobinemia range from none to life-threatening hypoxemia, cyanosis and respiratory compromise. Treatment is indicated at levels above 20% and at lower levels if the patient is significantly anemic. We present a case of a 60-year-old male with diffuse large B cell lymphoma at high risk of tumor lysis syndrome. Rasburicase was administered to prevent renal failure and further rise in uric acid. Twenty-four hours later, a bedside pulse oximetry showed an oxygen saturation ranging from 60 to 65% with minimal cyanosis. Co-oximetry revealed a methemoglobin level of 9.8%. Methylene blue was administered and the methemoglobin level decreased to 2.6%. However, the patient developed hemolysis several hours later, likely secondary to rasburicase and methylene blue, requiring transfusion support. We discuss this potentially fatal and initially asymptomatic adverse effect of rasburicase along with diagnostic and treatment considerations, and review the cases described in the current literature.
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Affiliation(s)
- Uroosa Ibrahim
- 1 Department of Hematology/Oncology, Staten Island University Hospital, Staten Island, NY, USA
| | - Amina Saqib
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
| | - Farhan Mohammad
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
| | - Jean Paul Atallah
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
| | - Marcel Odaimi
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
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Analyse des recommandations britanniques 2015 sur la prévention et la prise en charge du syndrome de lyse tumorale. Rev Med Interne 2017; 38:36-43. [DOI: 10.1016/j.revmed.2016.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/24/2022]
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Sherwood GB, Paschal RD, Adamski J. Rasburicase-induced methemoglobinemia: case report, literature review, and proposed treatment algorithm. Clin Case Rep 2016; 4:315-9. [PMID: 27099716 PMCID: PMC4831372 DOI: 10.1002/ccr3.495] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/22/2015] [Accepted: 12/25/2015] [Indexed: 11/11/2022] Open
Abstract
Rasburicase for the treatment of tumor lysis syndrome has been associated with hemolytic anemia and methemoglobinemia, usually in patients with G6PD deficiency. Risks and benefits should be considered prior to use of rasburicase in at‐risk patients. Methylene blue will worsen the hemolytic anemia in G6PD deficiency and should be avoided.
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Affiliation(s)
- Garrett B Sherwood
- Internal Medicine Resident University of Alabama at Birmingham Birmingham Alabama
| | - Rita D Paschal
- Department of Medicine University of Alabama at Birmingham Birmingham Alabama
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology Mayo Clinic Scottsdale Arizona
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