Which of the following drugs are effective in preventing uric acid nephropathy in patients receiving chemotherapy? 1. Probenecid 2. Forced saline diuresis 3. Rasburicase 4. Acetazolamide Select the correct answer using the code given below.
Preventing Uric Acid Nephropathy During Chemotherapy
Uric acid nephropathy is a potential complication of chemotherapy, often linked to Tumor Lysis Syndrome (TLS). TLS causes rapid breakdown of cancer cells, leading to a surge in uric acid levels. High uric acid can crystallize in the kidneys, causing damage. Preventing this requires managing uric acid levels and solubility.
Analyzing Prevention Methods
Let's examine the effectiveness of each option:
- 1. Probenecid: This medication promotes the excretion of uric acid. However, in TLS, increased uric acid excretion can lead to crystal formation in the kidneys, especially with high levels. Therefore, it's generally not recommended and can be contraindicated.
- 2. Forced Saline Diuresis: Administering large volumes of saline solution increases urine output. This dilutes the uric acid concentration in the renal tubules and facilitates its removal, helping to prevent precipitation and nephropathy. This is a standard supportive measure.
- 3. Rasburicase: This enzyme converts uric acid into allantoin, a substance that is much more water-soluble and easily excreted by the kidneys. Rasburicase significantly reduces serum uric acid levels, making it highly effective in preventing uric acid nephropathy during TLS.
- 4. Acetazolamide: This drug inhibits carbonic anhydrase, leading to urine alkalinization. Raising urine pH increases the solubility of uric acid, thereby reducing the risk of crystal formation and kidney damage.
Conclusion on Effective Strategies
Considering the mechanisms:
- Forced saline diuresis (2) helps by dilution and excretion.
- Rasburicase (3) breaks down uric acid effectively.
- Acetazolamide (4) increases uric acid solubility by alkalinizing urine.
Probenecid (1) is generally not suitable for preventing uric acid nephropathy in this setting.
Therefore, the combination of forced saline diuresis, rasburicase, and acetazolamide constitutes effective measures.
Important Questions from Renal Failure
Which of the following statements are correct regarding anti-glomerular basement membrane disease?
1. It is a rare autoimmune disease which presents as rapidly progressive glomerulonephritis.
2. Antibodies are formed against $α3$ chain of type 4 collagen GBM.
3. The $α3$ chain is expressed in basement membrane of glomerulus and the retina.
4. The disease may be associated with retinal hemorrhage when it is known as Goodpasture syndrome.
Select the answer using the code given below :
Which of the following are poor prognostic indictators in glomerular disease?
1. Female sex
2. Hypertension
3. Persistent and severe proteinuria
4. Elevated creatinine levels at presentation
Select the correct answer using the code given below:
Which of the following are indications for a renal biopsy?
1. Chronic kidney disease of uncertain etiology
2. Nephritic syndrome
3. Uncontrolled severe hypertension
4. Renal transplant dysfunction
Select the correct answer using the code given below:
- Which of the following is the correct range of Glomerular Filtration Rate (GFR) for Stage 2 chronic kidney disease?
- Which one of the following drugs is associated with calciphylaxis in chronic kidney disease patients?
