Spontaneous tumor lysis syndrome in diffuse large B-cell lymphoma patient as a cause of acute kidney injury (original) (raw)
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Acute renal failure due to tumor lysis syndrome in a patient with non-Hodgkin’s lymphoma
Annals of Hematology, 2005
Tumor lysis syndrome is characterized by multiple metabolic derangements resulting from the release of intracellular components into the bloodstream due to abrupt malignant cell death, spontaneously or following antineoplastic therapy. The syndrome is characterized by hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia, while deposition of uric acid and calcium phosphate crystals may result in acute renal failure, which is often exacerbated by concomitant intravascular volume depletion. A case of tumor lysis syndrome complicated by acute renal failure in a patient with non-Hodgkin’s lymphoma is reported and the pathophysiology, the clinical features, and the treatment options are discussed.
Tumor Lysis Syndrome in Chronic Lymphocytic Leukemia: A Rare Case Report from Nephrology
American Journal of Case Reports, 2019
Unusual clinical course Background: Tumor lysis syndrome is common in hematological malignancy, but less frequent in chronic and solid tumors. Almost always it is observed after chemotherapy or radiotherapy initiation, but rarely occurs spontaneously. Case Report: A 89-year-old female with stable chronic lymphocytic leukemia was admitted to the hospital because of worsening dyspnea and dry cough. Her vital signs were normal, except for sinus tachycardia. On physical examination, she appeared distressed, dyspneic, sweaty but afebrile, anxious, but alert and well oriented. Lung examination revealed reduced air entry with bibasilar crackles. No peripheral edema was seen, pulses were normal, and no signs of deep vein thrombosis were observed. Laboratory analysis revealed leukocytosis; but normal hematological and biochemical parameters. Intravenous (IV) furosemide and antibiotics (IV ceftriaxone and orally azithromycin) were started along with steroid therapy (methylprednisolone 62.5 mg, IV). The treatment with steroids lasted for 1 day only, and in the following day, the patient was switched to prednisone (20 mg/day orally) for only 1 additional day. White blood cell count increased on day 1, 2 and 3 after admission, along development of hyperuricemia, hyperphosphatemia, hyperkalemia, acute renal failure and elevated troponin levels. Hemodiafiltration/hemodialysis was initiated, and the patient was discharged after serum concentrations of these electrolytes and kidney function were restored. One month after discharge, the patient denied any malaise and was at stable condition. Conclusions: Herein, we present a case of a patient with stable chronic lymphocytic leukemia, who developed spontaneous tumor lysis syndrome after short low dose of steroid therapy. This case highlights the importance of including spontaneous tumor lysis syndrome in the differential diagnosis of any acute renal failure in the constellation of any malignancy.
Rare presentation of renal failure related to tumor lysis syndrome
Caspian Journal of Pediatrics (CJP), 2018
Background: Tumor lysis syndrome (TLS) which mostly occurs in lymphoproliferative malignancies after the start of chemotherapy is an oncologic emergency. Manifestations of metabolic imbalance including increasing hyperkalemia, hyperphosphatemia, hyperuricemia and hypocalcemia are common presentation of TLS. Case report: We present two cases of spontaneous TLS; a rare presentation of TLS before cytotoxic chemotherapy. These cases were admitted with presentation of TLS without any history of chemotherapy with mediastinal mass in chest X-ray (CXR) and subsequent diagnosis of lymphoblastic lymphoma and T-cell acute lymphocytic leukemia (ALL). After several hemodialysis sessions, their conditions were improved and they underwent chemotherapy. Conclusions: It was found that the presentation of mediastinal mass in cases of lymphoma and acute leukemia might be associated with TLS before chemotherapy. In addition, it is important to pay attention to CXR, when we face to a patient with acute renal failure related to TLS.
Acute renal failure in a patient with diffuse large B-cell lymphoma: case report
Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences, 2012
Renal parenchymal involvement is common in systemic lymphomas. In almost all cases, renal involvement appears to be a secondary process, either by direct extension from a retroperitoneal mass or via haematogenous spread in the setting of disseminated disease. Secondary renal involvement in systemic lymphomas is generally presented as multiple masses, but also as a solitary nodule. Acute renal failure by a lymphoma infiltration of the kidney is extremely rare. Primary renal non-Hodgkin's lymphoma is even more uncommon and it is a debated issue because of the absence of lymphoid tissue in normal kidneys. Case presentation: We report on the case of a 62-year old woman, who had melena, abdominal pain, malaise and fever. She was hospitalized at the Nephrology Clinic due to severe anemia and signs of acute renal failure. The peripheral blood smear showed the presence of dysplastic erythroblasts and hypo-granular neutrophils. Ultrasound was performed, which showed enlarged kidneys with signs of urinary obstruction of the first degree, with swollen, hypoechogenic parenchyma. After not responding to the conducted treatment, the patient died from heart failure. An autopsy was performed and Non-Hodgkin's, diffuse large B-cell lymphoma infiltrating multiple parenchymal organs was determined as the main cause of death. Conclusion: Diffuse large B-cell lymphoma with multiple organ affection and secondary renal involvement, presented as an acute renal failure is a rare case. We report on this case to update the literature concerning this topic and highlight the importance of renal biopsy in the diagnostics.
TUMOR LYSIS SYNDROME: ETIOLOGIES, PATIENT PROFILE, MANAGEMENT AND THERAPY (Atena Editora)
TUMOR LYSIS SYNDROME: ETIOLOGIES, PATIENT PROFILE, MANAGEMENT AND THERAPY (Atena Editora), 2024
Introduction: Tumor lysis syndrome (TLS) is an oncological emergency caused by the massive disintegration of tumor cells and the abrupt release of intracellular contents, such as potassium, phosphate and nucleic acid, into the bloodstream. Objectives: To present the main concepts of SLT, focusing on its etiologies, patient profile, management and therapy. Methodology: A narrative review of the literature was carried out based on 24 articles, which varied between 2016 and 2023. Results: TLS is an underreported oncological emergency that occurs after initiation of treatment for hematological malignancies. As etiologies, we can mainly mention chemotherapy. Its main risk factors include tumor characteristics such as metastatic disease and high proliferation rate. The pathophysiology directly correlates with the clinical picture, as it results from the release of potassium, phosphorus and nucleic acid ions into the bloodstream. The main manifestation of the disease may be acute kidney injury (AKI), caused by hyperuricemia or precipitation of calcium phosphate. For diagnosis and risk stratification of the syndrome, the Cairo and Bishop criteria are used, consisting of laboratory evaluation and the patient's clinical picture. The management of TLS must begin with the appropriate investigation of the disease by prior identification of the patient's profile and risk factors, looking for signs and symptoms such as weight loss, fever, bleeding and lymph node disease. The main approach is isotonic hydration. Conclusion: TLS is an oncological emergency and can be triggered by chemotherapy and spontaneous cell lysis. The clinical picture of the pathology presents with ARF, cardiac arrhythmias, nausea, vomiting, lethargy and sudden death. Management must be individualized and involves isotonic hydration and urate lowering. In case of refractory AKI, oral phosphate binders, diuretics and emergency hemodialysis can be adopted.
International Journal of Medical Research and Health Sciences, 2019
Background: Tumor lysis syndrome (TLS) is a group of metabolic derangements after the malignant cells die with treatment and leads to complications such as acute renal failure, cardiac arrhythmias, seizures, multiple organ failure, and sudden death. TLS is a common potentially preventable complication of hematological malignancies which are the most common cancers in our province. But the data about frequent complications in the course of their management such as TLS is rudimentary. Objective: The main objective of this study was to determine how frequently TLS occurs in our patients. Design and methods: A descriptive cross-sectional study was designed and conducted in Pathology Department, King Edward Medical University, Lahore (February 2014-July 2014). Newly diagnosed patients of hematological malignancies were enrolled in the study. The clinical parameters such as age, gender and laboratory parameters such as laboratory diagnosis, Complete Blood Count, Serum Potassium, Serum LDH...
Multiple recurrences of acute tumor lysis syndrome in an indolent non-hodgkin's lymphoma
Cancer, 1985
Acute tumor lysis syndrome (ATLS) is an entity consisting of combinations of hyperuricemia, lactic acidosis, hyperkalemia, hyperphosphatemia, and hypocalcemia and occurring generally in aggressive, rapidly proliferating lymphoproliferative disorders with high tumor burdens. A patient is described with a diffuse intermediately differentiated lymphocytic lymphoma, considered by most an indolent B-cell non-Hodgkin's lymphoma, in whom developed multiple recurrences of ATLS after treatment when tumor regrowth occurred between cycles of therapy. The mitotic rate of this lymphoma was relatively high (30-80 mitoses/ten high-power fields). Lymph proliferative disorders with a high mitotic rate, and large tumor burden, regardless of histologic features, should be treated prophylactically against tumor lysis if regrowth between cycles occurs.