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]

参考译文

由尿酸导致肾脏疾病的原因可归结为：结石性泌尿道阻塞；管内尿酸结晶沉积(如肿瘤溶解综合征中的过渡合成)或间质肾病(如在高尿酸血症肾病中)。此外，尿酸结石含有酸核，通常由草酸钙盐结晶沉积覆盖而成,这有利于结石增大,同时也改变了其放射学特性。

区别二者诊断的不同就要求将患者的基础病理学、发生的临床背景、放射学检查、参数分析以及在肾损伤恢复阶段观察到的临床进展本身结合在一起。

理论上讲，拉布立酶能够通过肾小球过滤,通过尿液大量清除。通过这种方法，它可以作用于管内尿酸，溶解结晶并促使其排出。此机制有助于缩短肿瘤溶解综合征导致的急性肾功能衰竭的发展。我们还假设拉布立酶能够进入尿道，并能在肾盏、肾盂、输尿管中溶解含有尿酸成分的结石，以利结石排出。如果在体内或体外都能证实拉布立酶能够溶解尿酸结石，那么，通过肾造口术导管进人尿道直接给药将会成为这种常见病患者的一种新的治疗方法。

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