CASE REVIEW

42 year male with Chronic myeloid Leukemia developed acute renal failure 2 days

After start of Chemothrapy. There was no history given for hypotension episode.

Physical examination revealed generalized wasting , and lymphadenopathy,splenomegally.

Urine out put was near to 400 ml in 24 hour.

Lab revealed:

S. creatinine 5.2 mg/dl.

Urea 80mg/dl.

S. K 5.2, Hco3 18, s.ca 1.5 mmole/l

Po4 13.4:  Uric acid 19 mg/dl

His fraction excretion of sodium was 3%. And urine analysis shows mudy brown cast and

Epithelial cells.

Q. What is the diagnosis and How will u manage it?

Answere: 

This is case of acute uric acid nephropathy secondary to Tumor lysis syndrome.

Acutely rise of uric acid cause renal failure due to precipitation of uric acid within

The tubules as there was massive cell necrosis following chemotherapy. This diagnosis

Is favoured biochemically by high potassium and high phosphorus and decreased calcium.

Management starts by hydration, alkalinization of urine followd by allopurinol therapy.

New drug Rasburicase can also be given to reduce already massive load of uric acid.