title: Role of serum sodium in assessing hospital mortality in  cancer patients with spontaneous tumour lysis syndrome  inducing acute uric acid nephropathy.
abstract: Spontaneous tumour lysis syndrome (STLS) inducing acute uric acid nephropathy, a rare and neglected disease, presents more insidiously than conventional post-treatment tumour lysis syndrome. Although STLS is a serious and potentially fatal complication in patients with neoplastic disorders, few investigations have addressed the relevance of clinical and laboratory features in assessing prognosis. A retrospective study was conducted, reviewing the records of all patients who developed acute renal failure (ARF) at Chang Gung memorial hospital between 1 July 1999 and 30 June 2003. STLS-induced acute uric acid nephropathy was identified in 12 of 1072 ARF patients (1.1%) during the study period. All patients had advanced stage tumours with large tumour burden, and 66.7% of cases had abdominal organ involvement. All 12 hyperuricemic patients became oliguric despite conservative therapy, and remained hyperuricemic (21.6 +/- 5.2 mg/dl) before dialysis therapy. Diuresis developed in eight patients (66.7%), with associated resolution of hyperuricemia, azotemia and metabolic derangements following dialysis initiation. Overall hospital mortality was 58.3%. Death in most patients was related to hyponatremia and hypoalbuminemia on admission. The serum sodium was found to have the best Youden index (0.86) and highest overall prediction accuracy (93%). Moreover, serum sodium and serum albumin for individual patients were significantly and positively correlated (r = 0.617, p = 0.032). This investigation confirms a grave prognosis for cancer patients with STLS inducing acute uric acid nephropathy. Hyponatremia and hypoalbuminemia on the first day of admission indicate poor prognosis in such patients.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: H-H
authors.initials: HH
authors.lastname: Hsu
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chen
authors.forename: Y-C
authors.initials: YC
authors.lastname: Tian
authors.forename: Y-L
authors.initials: YL
authors.lastname: Chan
authors.forename: M-C
authors.initials: MC
authors.lastname: Kuo
authors.forename: C-C
authors.initials: CC
authors.lastname: Tang
authors.forename: J-T
authors.initials: JT
authors.lastname: Fang
authors.forename: S-Y
authors.initials: SY
authors.lastname: Lee
authors.forename: C-W
authors.initials: CW
authors.lastname: Yang
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D033461:Hyperuricemia / Q000209:etiology; D034141:Hypoalbuminemia / Q000209:etiology / Q000401:mortality; D007010:Hyponatremia / Q000209:etiology / Q000401:mortality; D007890:Leiomyosarcoma / Q000150:complications / Q000401:mortality; D007938:Leukemia / Q000150:complications / Q000401:mortality; D008223:Lymphoma / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood*; D016019:Survival Analysis; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000150:complications / Q000401:mortality*
chemical_list: D012964:Sodium