The frequency of acute renal failure in very low birth weight infants is 6-8% in neonatal intensive care units [1]. Hyperuricemia is a frequent observation in these infants. Few reports have described successful use of rasburicase in infants and neonates for hyperuricemia in different indications [2-4]. A preterm baby with a gestational age of 26 weeks and a birthweight of 780 g was born by vaginal delivery to a 24 year old mother. She had clinical sepsis on 3rd postnatal day, associated with oliguria. She had scleredema, anemia, low platelets and hypotension. Antibiotics, inotropic agents, blood transfusion and intravenous immunglobulin were given for supportive care. Biochemical parameters were as follows, blood urea nitrogen, 45.8 mg/dL; creatinine, 1.97 mg/dL; sodium, 173 mg/dL; potasium 5.9 mg/dL and uric acid 17.2 mg/dL. She developed acute renal failure and hyperuricemia, furosemide infusion started (0.1 mg/kg/hour) and rasburicase was given as a single dose of 0.2 mg/kg intravenous. Twelve hours after administration of rasburicase, uric acid level decreased to 0.55 mg/dL. Diuresis occured and vital signs, biochemical parameters (blood urea nitrogen, 23 mg/dL; creatinin, 1.34 mg/dL; sodium, 143 mg/dL, potasium 5.02 mg/dL), and clinical appearence became normal.

This case demonstrates the use of rasburicase for hyperuricemia in an extremely low birth weight infant with acute renal failure. When the excretory capacity of the kidneys has been exceeded, hyperuricemia occurs. In scenarios such as this, and conditions like tumor lysis syndrome aggressive management of electrolyte abnormalities is required in addition to the measures taken to reduce hyperuricemia with rasburicase.