Onco-Nephrology

Wilson, F. Perry; Berns, Jeffrey S.

doi:10.2215/cjn.03150312

Cited by 119 publications

(103 citation statements)

References 92 publications

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“…Treatment of hyperkalemia in the emergency setting includes administration of potassium-binding agents (eg, Kayexalate) and hemodialysis. 6,7 Hyperphosphatemia is also commonly seen because malignant hematologic cells may contain up to 4 times more intracellular phosphate compared with normal mature lymphoid cells, and high cell turnover results in hyperphosphatemia as the serum concentration of phosphate exceeds the renal excretion threshold. Precipitation of calcium phosphate in the renal tubules subsequently results in hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

Renal Calculi: An Unusual Presentation of T-Cell Acute Lymphoblastic Leukemia

2016

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Spontaneous tumor lysis syndrome is a rare initial presentation of hematologic malignancy in children that typically presents with complications of electrolyte derangement, specifically hyperkalemia, hyperphosphatemia, and hyperuricemia. We report a case of a 5-year-old boy who presented to the emergency department with gross hematuria, abdominal pain, and vomiting and was ultimately diagnosed with uric acid nephrolithiasis and acute renal failure secondary to spontaneous tumor lysis syndrome in the setting of T-cell acute lymphoblastic leukemia. Tumor lysis syndrome is considered an oncologic emergency, and in this case, the child required urgent treatment with potassium-binding agents, rasburicase, and hemodialysis. This case demonstrates that occult hematologic malignancy should be suspected in cases of nephrolithiasis and acute renal failure when found in conjunction with hyperuricemia despite a normal complete blood count at the time of presentation.

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Section: Discussionmentioning

confidence: 99%

Renal Calculi: An Unusual Presentation of T-Cell Acute Lymphoblastic Leukemia

2016

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“…Intracellular phosphorous concentrations are high especially in Burkitt's lymphoma and B-cell acute lymphoblastic leukemia, with the incidences of TLS being previously reported as 14.9% and 26.4%, respectively [5]. Darmon et al reported that serum phosphate levels, the tumor burden as assessed by LHD and DIC, were associated with clinical TLS, and a 1 mmol increase in serum phosphate levels was associated with a 5-fold increase in the risk of clinical TLS [1].…”

Section: Discussionmentioning

confidence: 99%

Severe Hyperphosphatemia Resulting in Acute Renal Failure and Ischemic Encephalopathy in a Patient with Infantile Leukemia

Watanabe¹,

Itano²,

Koga³

et al. 2014

CRCM

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Tumor lysis syndrome (TLS), hyperleukocytosis, and disseminated intravascular coagulation (DIC) are representative oncological emergencies that overlap mutually at the beginning of therapy for aggressive leukemia. Lately recombinant urate oxidase (rUO) enables to control uric acid level and its crystallization, the most frequent risk factor for clinical TLS; therefore, hyperphosphatemia appears to be the main risk in the rUO era. We here report an infantile leukemia patient who developed severe hyperphosphatemia, resulting in acute renal failure and ischemic encephalopathy. A 9-month-old female baby was adynamic with a bulging anterior fontanel, and was diagnosed as infantile acute lymphoblastic leukemia with a mixed lineage leukemia gene rearrangement. A laboratory examination revealed leukocytosis, bicytopenia, hyperuricemia, a prolonged prothrombin time, activated partial thromboplastin time, and elevated lactate dehydrogenase level. Soon after a reduced dose of prednisolone was administered, she developed hypoxia caused by systemic inflammatory response syndrome and heart failure. Her white blood cell count decreased sharply, leading to acute renal failure due to hyperphosphatemia, which required continuous hemodiafiltration for 48 hours. Although renal function subsequently recovered, severe ischemic encephalopathy remained. She achieved morphological remission once, however, relapsed and passed away soon after. We have to pay attention to the progression of hyperphosphatemia, hyperkakemia and DIC, although hyperuricemia was controlled using rUO. Changes in electrolyte * Corresponding author. A. Watanabe et al. 130levels must be continuously monitored, and TLS, DIC and/or hyperleukocytosis should be promptly managed especially in patients who are sensitive to therapy.

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“…The treatment consists of aggressive hydration, correction of electrolyte disturbances and uric acid-lowering therapy. If dialysis is required, continuous modalities may be favored, particularly in patients with more severe TLS [11]. Continuous therapies did not perform due to unavailable solutions.…”

Section: Discussionmentioning

confidence: 99%

Concurrent acute spontaneous tumor lysis syndrome complicated with multiple organ failure in a patient with pre-existing undiagnosed lung cancer

Amiri

2015

CEN Case Rep

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Acute kidney injury, a common complication associated with malignancy, occurs in various clinical situations for numerous reasons. Acute tumor lysis syndrome (TLS) is possibly the most significant cause of acute kidney injury in cancer patients, because it is fulminant at onset and associated with severe metabolic derangements. Acute spontaneous tumor lysis syndrome is rare and most of the related malignancies belong to hematologic malignancies but it has seldom been investigated as bulky or advanced metastatic non-hematologic malignancies. TLS comprises a clinical laboratory derangement of cellular metabolism which can lead to acute renal impairments, cardiac arrhythmia, seizures and patient demise. Prevention and treatment of tumor lysis syndrome depends on early recognition of at-risk patients, volume repletion and xanthin oxidase inhibitors. In addition, in patients with high risk tumor types, prophylactic use of rasburicase before chemotherapy is required. If dialysis is required, continuous modalities may be favored, particularly in patients with more severe TLS. This case report discusses a 79-year-old man with controlled Alzheimer's disease presented with picture of septic shock and multiorgan dysfunction (acute kidney injury, acute lung injury, acute brain injury) pulmonary suppuration in the right lung field due to aspiration pneumonia with infection-induced systemic inflammatory response (SIRS) was diagnosed. Further workup revealed lung cancer on chest CT scan. Antibiotic, respirator and hemodialysis treatment improved his condition but died several days later. Acute spontaneous TLS may present in association with infectious SIRS and multiple organ failure, the combination of which results in significant mortality.

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Onco-Nephrology

Cited by 119 publications

References 92 publications

Renal Calculi: An Unusual Presentation of T-Cell Acute Lymphoblastic Leukemia

Renal Calculi: An Unusual Presentation of T-Cell Acute Lymphoblastic Leukemia

Severe Hyperphosphatemia Resulting in Acute Renal Failure and Ischemic Encephalopathy in a Patient with Infantile Leukemia

Concurrent acute spontaneous tumor lysis syndrome complicated with multiple organ failure in a patient with pre-existing undiagnosed lung cancer

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