Pediatric Nephrology

, Volume 22, Issue 1, pp 132–135 | Cite as

Acute renal failure from xanthine nephropathy during management of acute leukemia

  • Christopher LaRosa
  • Laura McMullen
  • Suzanne Bakdash
  • Demetrius Ellis
  • Lakshmanan Krishnamurti
  • Hsi-Yang Wu
  • Michael L. Moritz
Brief Report

Abstract

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.

Keywords

Xanthine Nephrolithiasis Acute renal failure Allopurinol Tumor lysis 

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Copyright information

© IPNA 2006

Authors and Affiliations

  • Christopher LaRosa
    • 1
  • Laura McMullen
    • 1
  • Suzanne Bakdash
    • 4
  • Demetrius Ellis
    • 2
  • Lakshmanan Krishnamurti
    • 3
  • Hsi-Yang Wu
    • 5
  • Michael L. Moritz
    • 2
  1. 1.Department of PediatricsChildren’s Hospital of PittsburghPittsburghUSA
  2. 2.Division of NephrologyChildren’s Hospital of PittsburghPittsburghUSA
  3. 3.Division of Hematology-OncologyChildren’s Hospital of PittsburghPittsburghUSA
  4. 4.Department of PathologyThe University of Pittsburgh School of MedicinePittsburghUSA
  5. 5.Department of UrologyThe University of Pittsburgh School of MedicinePittsburghUSA

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