Kopecna L, Dolezel Z, Osvaldova Z, Starha J, Hrstkova H
Bratisl Lek Listy. 2002;103(6):206-9.
Acute renal failure (ARF) during the course of cytostatic therapy is a serious complication. ARF can be isolated or became as component of tumour lysis syndrome (TLS). TLS comprises a number of metabolic abnormalities (hyperuricemia, hyperphosphatemia, hyperkalemia, azotemia and hypocalcemia) which are associated with lymphoproliferative malignancies following spontaneous or chemotherapy-induced cytolysis. There exist probably no clear prediction for the development of TLS that could enable early detection of manifestation of this severe condition.
Conventional management with aggressive hydration, alkalization of the urine, administration of allopurinol, and the slow introduction of chemotherapy is often unable to prevent metabolic instability and ARF. Recent studies define a subgroup of patients at higher risk of renal failure during induction chemotherapy. ARF was encountered during initial therapy of patients with a lactate dehydrogenase (LDH) index greater than 3.3.
A retrospective analysis of 10 children (3 girls, 7 boys, average age 9.7 years) with LDII index greater than 3.3 has been done. All children were treated for lymphoproliferative malignancy with conventional preventive measures.
Three children needed haemodialysis--2 boys had fully expressed TLS with ARF shortly after starting chemotherapy, in 1 boy the dialysis was indicated because of extreme hyperuricemia and high creatinine level presented before chemotherapy. We consider that LDH index is not specific criterium for prediction of TLS. In conclusion, our cases demonstrate the pathophysiologic spectrum of ARF in TLS between hyperuricemia and hyperphosphatemia.
The LDH index, urine output, and hyperphosphatemia could be used to identify those paediatric patients who would benefit from the prospective use some of extracorporeal elimination methods. Further investigation of this techniques in a larger number of patients is warranted. (Tab. 5, Ref. 12.)
细胞毒性治疗过程中的急性肾衰竭（ARF）是一种严重的并发症。ARF可以是孤立的，也可以成为肿瘤溶解综合征（TLS）的组成部分。TLS包括一些代谢异常（高尿酸血症、高磷血症、高钾血症、氮质血症和低钙血症），这些异常与自发或化疗诱导的细胞溶解后发生的淋巴增殖性恶性肿瘤有关。对于TLS的发生可能没有明确的预测方法能够早期发现这种严重疾病的表现。
采用积极补液、尿液碱化、给予别嘌呤醇以及缓慢引入化疗的传统治疗方法往往无法预防代谢不稳定和ARF。最近的研究确定了一组在诱导化疗期间发生肾衰竭风险较高的患者亚组。在乳酸脱氢酶（LDH）指数大于3.3的患者初始治疗期间出现了ARF。
对10名LDH指数大于3.3的儿童（3名女孩，7名男孩，平均年龄9.7岁）进行了回顾性分析。所有儿童均采用传统预防措施治疗淋巴增殖性恶性肿瘤。
3名儿童需要血液透析——2名男孩在开始化疗后不久出现了伴有ARF的完全性TLS，1名男孩因化疗前出现极度高尿酸血症和高肌酐水平而需要透析。我们认为LDH指数不是预测TLS的特异性标准。总之，我们的病例展示了TLS中ARF在高尿酸血症和高磷血症之间的病理生理范围。
LDH指数、尿量和高磷血症可用于识别那些将从前瞻性使用某些体外清除方法中获益的儿科患者。有必要在更多患者中对这项技术进行进一步研究。（表5，参考文献12）
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