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NDT Plus Advance Access published online on August 22, 2008
NDT Plus, doi:10.1093/ndtplus/sfn133
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Massive uric acid nephrolithiasis with progressive renal failure due to spontaneous tumour lysis syndrome

Johannes Trachsler1, Ariana Gaspert2, Marco Previsdomini3, Rudolf P. Wüthrich1 and Thomas Fehr1

1 Clinic for Nephrology
2 Department of Pathology
3 Medical Intensive Care Unit, University Hospital/Zürich Medical School, Zürich, Switzerland

Correspondence: Thomas Fehr, Clinic for Nephrology, University Hospital, Rämistrasse 100, CH-8091 Zürich, Switzerland. Tel: +41-44-255-2775; Fax: +41-44-255-4593; E-mail: thomas.fehr{at}access.uzh.ch


  Abstract

Tumour lysis syndrome (TLS) is a constellation of meta- bolic complications due to the rapid destruction of malignant cells, causing renal, cardiac or cerebral dysfunction. Electrolyte abnormalities include hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia. TLS-induced renal failure is mainly caused by uric acid and calcium phosphate crystal deposition and usually develops following cytotoxic chemotherapy. Here, we present a case of spontaneous TLS in a patient with chronic myelomonocytic leukaemia (CMML) with massive uric acid stone and crystal formation and rapidly worsening renal failure. Autopsy revealed underlying tumourous kidney infiltration. Risk factors for occurrence of TLS and current therapeutic management are discussed.

Key Words: acute renal failure • therapy • tumour lysis syndrome • uric acid nephrolithiasis

Received for publication July 20, 2008. Accepted for publication July 24, 2008.


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