Rescue Therapies for AKI in Onconephrology: Rasburicase and Glucarpidase

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.

Keywords: AKI; Glucarpidase; acute kidney injury; high-dose leucovorin; high-dose methotrexate toxicity; hyperuricemia; leucovorin rescue; methotrexate; mortality; rasburicase; tumor lysis syndrome; uricase.