Post-cytokine-release Salt Wasting as Inverse Tumor Lysis Syndrome in a Non-cerebral Natural Killer-cell Neoplasm

Abstract

The pathogenesis of cerebral/renal salt-wasting syndrome remains unknown. We herein present a case of salt-wasting syndrome with a natural killer-cell neoplasm without cerebral invasion. A 78-year-old man with hemophagocytic syndrome received two cycles of chemotherapy that did not induce tumor lysis syndrome, but repeatedly caused polyuria and natriuresis. The expression of tumor necrosis factor-α in the neoplasm led us to hypothesize that an oncolysis-induced cytokine storm may have caused renal tubular damage and salt wasting. Our theory may explain the pathogenic mechanism of cerebral/renal salt-wasting syndrome associated with other entities, including cerebral disorders, owing to the elevation of cytokine levels after subarachnoid hemorrhage.

Hyponatremia in Patients with Hematologic Diseases

“…Another term for CSWS is renal salt wasting syndrome (RSWS), given that the presence of cerebral disease is not necessary [ 69 ]. Hyponatremia due to renal salt loss ascribed to oncolysis-induced cytokine release has been reported in a patient suffering from natural killer-cell neoplasm accompanied by hemophagocytic syndrome [ 70 ]. Salt-losing nephropathy has also been attributed to leukemia-induced tubular defect [ 47 ].…”