Renal disease produced by uric acid can be due to lithiasic urinary tract obstruction,to intra-tubular precipitation of uric acid crystals (in case of overproduction as in tumoral lysis syndrome)or to interstitial nephropathy (as in hyperuricemic  nephropathy). Besides, uric acid stones usually contain a uric core frequently covered by deposition of calcium oxalate crystals, which favors the growthof the calculi and modifies the radiological characteristics.

Making the differential diagnosis between them requires bringing together the underlying pathology of the patient,the clinical setting in which it occurs, the radiological findings, the analytical parameters.and the clinical progression itself observed during the recovery phase of renal damage.

Therefore, Rasburicase is theoretically able to pass through the glomerular filter and be eliminated in the urine in a significant quantity. In this way it acts on intra-tubular uric acid, dissolves the crystals and promotes their elimination. This mechanism helps to shorten the evolution of the acute established renal failure in case of turnoral lysis syndrome. We also hypothesize that Rasburicase can reach the urinary tract and dissolve the stones with a uric acid component within the calyces, pelvis and ureter, favoring their elimination. If the capability of Rasburicase to dissolve uric acid stones is confirmed either in vitro or in vivo,the direct administration of the drug in the urinary tract through nephrostomy catheters could be a new therapeutic approach in patients with this common pathology.

                                                                                              [Nefrologia,2008;28 (1)102-105]

參考譯文

由尿酸導(dǎo)致腎臟疾病的原因可歸結(jié)為：結(jié)石性泌尿道阻塞；管內(nèi)尿酸結(jié)晶沉積(如腫瘤溶解綜合征中的過渡合成)或間質(zhì)腎病(如在高尿酸血癥腎病中)。此外，尿酸結(jié)石含有酸核，通常由草酸鈣鹽結(jié)晶沉積覆蓋而成,這有利于結(jié)石增大,同時(shí)也改變了其放射學(xué)特性。

區(qū)別二者診斷的不同就要求將患者的基礎(chǔ)病理學(xué)、發(fā)生的臨床背景、放射學(xué)檢查、參數(shù)分析以及在腎損傷恢復(fù)階段觀察到的臨床進(jìn)展本身結(jié)合在一起。

理論上講，拉布立酶能夠通過腎小球過濾,通過尿液大量清除。通過這種方法，它可以作用于管內(nèi)尿酸，溶解結(jié)晶并促使其排出。此機(jī)制有助于縮短腫瘤溶解綜合征導(dǎo)致的急性腎功能衰竭的發(fā)展。我們還假設(shè)拉布立酶能夠進(jìn)入尿道，并能在腎盞、腎盂、輸尿管中溶解含有尿酸成分的結(jié)石，以利結(jié)石排出。如果在體內(nèi)或體外都能證實(shí)拉布立酶能夠溶解尿酸結(jié)石，那么，通過腎造口術(shù)導(dǎo)管進(jìn)人尿道直接給藥將會(huì)成為這種常見病患者的一種新的治療方法。

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