Acute lymphoblastic leukemia presenting as acute renal failure.
BACKGROUND
A 42-year-old previously healthy man presented with acute-onset headache and facial paralysis. He was treated for Bell's palsy with corticosteroids and valaciclovir. One week later, he developed acute renal failure requiring hospitalization.


METHODS
Physical examination, laboratory tests, urinalysis, renal ultrasound, renal biopsy, bone marrow biopsy, lumbar puncture, CT of the chest, abdomen and pelvis, MRI of the brain, and whole-body PET scan.


METHODS
Acute lymphoblastic leukemia, bilateral renal enlargement secondary to leukemic infiltration, acute renal failure, tumor lysis syndrome, and leukemic involvement of the facial nerve.


RESULTS
The patient was treated with a modified induction chemotherapy regimen. He was given allopurinol for hyperuricemia and hydrated with alkalized intravenous fluids to prevent uric acid precipitation in the renal tubules. The profound tumor lysis that occurred after the cytotoxic chemotherapy required hemodialysis.
Suh
William M
WM
David Geffen School of Medicine at UCLA, Department of Medicine, 10833 Le Conte Avenue, Room 57-143, Los Angeles, CA 90095, USA. willsuh@gmail.com
Wainberg
Zev A
ZA
de Vos
Sven
S
Cohen
Arthur H
AH
Kurtz
Ira
I
Nguyen
Minhtri K
MK
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy; D006435:Renal Dialysis; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000209:etiology* / Q000628:therapy