title: Acute renal failure from xanthine nephropathy during management of acute leukemia.
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.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: LaRosa
authors.forename: Laura
authors.initials: L
authors.lastname: McMullen
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bakdash
authors.forename: Demetrius
authors.initials: D
authors.lastname: Ellis
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Krishnamurti
authors.forename: Hsi-Yang
authors.initials: HY
authors.lastname: Wu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Moritz
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000493:Allopurinol / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053040:Nephrolithiasis / Q000150:complications* / Q000209:etiology / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D015275:Tumor Lysis Syndrome / Q000150:complications / Q000188:drug therapy; D019820:Xanthine / Q000009:adverse effects* / Q000652:urine
chemical_list: D004791:Enzyme Inhibitors; D019820:Xanthine; D000493:Allopurinol