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Non-recombinant urate oxidase (Uricozyme®)

recombinant urate oxidase (Rasburicase®)

urine alkalisation may induce calcium phosphate deposition

renal replacement therapy should be started on an emergency basis when hydration fails to produce a prompt metabolic improvement or when ARF develops

Up to 50% of patients with newly diagnosed multiple myeloma have renal failure and up to 10% require dialysis

renal ultrasonography remains the method of choice for investigating extra-renal obstruction

The relief of the obstruction, either by percutaneous nephrostomy or through a ureteral stent, is the cornerstone of treatment

TMA may be associated with the cancer itself, with cancer chemotherapy, or with allogeneic BMT

thrombotic microangiopathy (TMA)

it may be as high as 5%

Most of the cases occur in patients with solid tumours, the most common type being adenocarcinoma (stomach, breast and lung)

The pathophysiology of the TMA-malignancy association remains controversial, although many studies suggest an insult to the vascular endothelium

mitomycin C. Subsequently, TMA has been reported with many anti-cancer agents, including gemcita-bine, bleomycin, cisplatin, CCNU, cytosine arabinoside, daunorubicin, deoxycoformycin, 5-FU, azathioprine and interferon α

Plasma exchanges have been shown to improve prognosis in the general population of patients with TMA

Causative factors should be looked for and antihypertensive treatment given. Lastly, in the absence of guidelines, we believe that plasma exchange should be proposed in patients with severe cancer treatment-associated TMA

The most widely used protective measure is saline infusion to induce solute diuresis

During methotrexate infusion and elimination, fluids should be given to maintain a high urinary output and urinary alkalisation should be performed to keep the urinary pH above 7.5. Rescue with folinic acid (50 mg four times a day) should be started 24 hours after each high-dose metho-trexate infusion and serum methotrexate concentrations should be measured every day

cyclophosphamide and ifosfamide