Bunchman T E, Gale G B, O'Connor D M, Salinas-Madrigal L, Chu J Y
Division of Pediatric Nephrology, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Clin Nephrol. 1992 Sep;38(3):142-4.
Hyperuricemia, due to inborn errors of metabolism, dehydration, or tumor lysis, may cause renal insufficiency. Hyperuricemia from tumor lysis syndrome in malignancy is usually associated with electrolyte disturbances such as hyperkalemia, hyperphosphatemia or hyper or hypocalcemia. Tumor infiltration into the kidneys can occur, yet this accounts for renal insufficiency in only 1% of patients. This infiltration of tumor cells into the kidneys is usually associated with evidence of malignancy elsewhere as identified by physical exam, radiographic studies, and examination of the peripheral smear or bone marrow. We report an unusual presentation of a child with acute lymphocytic leukemia presenting with acute renal failure, nephromegaly and hyperuricemia without electrolyte disturbances or systemic evidence of tumor elsewhere. We stress the importance of kidney biopsy in order to identify the etiology of the renal failure and hyperuricemia.
由于先天性代谢缺陷、脱水或肿瘤溶解导致的高尿酸血症可能会引起肾功能不全。恶性肿瘤中肿瘤溶解综合征所致的高尿酸血症通常与电解质紊乱相关，如高钾血症、高磷血症或高钙血症或低钙血症。肿瘤可浸润肾脏，但这仅占患者肾功能不全病因的1%。肿瘤细胞浸润肾脏通常与体格检查、影像学检查以及外周血涂片或骨髓检查所发现的其他部位恶性肿瘤证据相关。我们报告了一名急性淋巴细胞白血病患儿的不寻常表现，该患儿出现急性肾衰竭、肾肿大和高尿酸血症，但无电解质紊乱或其他部位肿瘤的全身证据。我们强调肾活检对于确定肾衰竭和高尿酸血症病因的重要性。
