Acute renal failure from xanthine nephropathy during management of acute leukemia

Tumor lysis syndrome is a potentially life-threatening complication of induction chemotherapy for treatment of lymphoproliferative malignancies. Serious complications of tumor lysis syndrome are rare with the preemptive use of allopurinol, rasburicase, and urine alkalinization. We report a case of o...

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Published in:Pediatric nephrology (Berlin, West) West), 2007-01, Vol.22 (1), p.132-135
Main Authors: LaRosa, Christopher, McMullen, Laura, Bakdash, Suzanne, Ellis, Demetrius, Krishnamurti, Lakshmanan, Wu, Hsi-Yang, Moritz, Michael L
Format: Article
Language:English
Subjects:
Acute Kidney Injury - diagnosis
Acute Kidney Injury - etiology
Allopurinol - adverse effects
Allopurinol - therapeutic use
Child
Enzyme Inhibitors - adverse effects
Enzyme Inhibitors - therapeutic use
Female
Humans
Nephrolithiasis - complications
Nephrolithiasis - etiology
Nephrolithiasis - pathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Tumor Lysis Syndrome - complications
Tumor Lysis Syndrome - drug therapy
Xanthine - adverse effects
Xanthine - urine
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Summary:Tumor lysis syndrome is a potentially life-threatening complication of induction chemotherapy for treatment of lymphoproliferative malignancies. Serious complications of tumor lysis syndrome are rare with the preemptive use of allopurinol, rasburicase, and urine alkalinization. We report a case of oliguric acute renal failure due to bilateral xanthine nephropathy in an 11-year-old girl as a complication of tumor lysis syndrome during the treatment of T-cell acute lymphoblastic leukemia. Xanthine nephrolithiasis results from the inhibition of uric acid synthesis via allopurinol which increases plasma and urinary xanthine and hypoxanthine levels. Reports of xanthine nephrolithiasis as a cause of tumor lysis syndrome are rare in the absence of defects in the hypoxanthine-guanine phosphoribosyl transferase (HGPRT) enzyme. Xanthine nephropathy should be considered in patients who develop acute renal failure following aggressive chemotherapy with appropriate tumor lysis syndrome prophylaxis. Urine measurements for xanthine could aid in the diagnosis of patients with nephrolithiasis complicating tumor lysis syndrome. Allopurinal dosage should be reduced or discontinued if xanthine nephropathy is suspected.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-006-0287-z