Urolithiasis in an Acute Lymphoblastic Leukemia Child During Induction Chemotherapy

Abstract

An 11-year-old acute lymphoblastic leukemia patient suddenly developed severe abdominal flank pain and hematuria caused by renal stone during induction chemotherapy. The patient was treated with forced hydration, and the pain was relieved after the renal stone passed through. The renal stone was composed of calcium phosphate. The patient is currently in continuous complete remission, has had no recurrence of the urolithiasis, and is on consolidation chemotherapy. Although urolithiasis is extremely rare in childhood acute lymphoblastic leukemia, it should be considered in patients who complain of abdominal flank pain or back pain during chemotherapy.

Drug-Induced Urolithiasis in Pediatric Patients

“…Three case reports in the literature demonstrated the occurrence of urolithiasis in two 11-year-old boys and one girl taking allopurinol during the induction of chemotherapy for the management of ALL [106,110,115]. In one boy, the stone passed following treatment by forced hydration, and on analysis, it showed calcium phosphate composition [106]. The other boy and the girl died, and the autopsy analysis of the stones showed xanthine composition [110,115].…”

“…Allopurinol is a xanthine oxidase inhibitor that is commonly used in the treatment of gout, to control the hyperuricemia occurring as a part of Lesch-Nyhan syndrome (LNS), and to prevent tumor lysis syndrome in patients with acute lymphoblastic leukemia (ALL) before the induction of chemotherapy [106,107]. Several reports demonstrated that allopurinol is associated with an increased risk of xanthine urolithiasis in children [106][107][108][109][110][111][112][113][114][115]. Table 3 summarizes all the reports of allopurinol-induced urolithiasis in the pediatric population discussed in the current review.…”

“…Several factors may contribute to the increased risk, including glucocorticoid therapy, which may increase the risk of urolithiasis up to 48-fold during induction and 22-fold during continuation therapy [116]. Furthermore, ALL chemotherapy may be associated with hyperuricemia and tumor lysis syndrome, which may increase the risk of urolithiasis in these patients [106]. Three case reports in the literature demonstrated the occurrence of urolithiasis in two 11-year-old boys and one girl taking allopurinol during the induction of chemotherapy for the management of ALL [106,110,115].…”

“…Furthermore, ALL chemotherapy may be associated with hyperuricemia and tumor lysis syndrome, which may increase the risk of urolithiasis in these patients [106]. Three case reports in the literature demonstrated the occurrence of urolithiasis in two 11-year-old boys and one girl taking allopurinol during the induction of chemotherapy for the management of ALL [106,110,115]. In one boy, the stone passed following treatment by forced hydration, and on analysis, it showed calcium phosphate composition [106].…”

“…The allopurinol dosage should be strictly adjusted not to exceed 5 mg/kg/day in children and 100 mg/day in adults to allow the reduction of serum uric acid production without overproduction of xanthine, thus reducing the risk of urolithiasis [107]. If these measures fail, other treatment options may be used, including SWL, percutaneous nephrolithotomy, endoscopy and open surgery [106][107][108][109][110][111][112][113][114][115].…”