Mir M A, Delamore I W
Br J Haematol. 1978 Sep;40(1):79-92. doi: 10.1111/j.1365-2141.1978.tb03641.x.
Metabolic balance studies were carried out in 17 unselected patients with acute myeloid leukaemia. Widespread metabolic disturbances were observed. Serum Na fell below 135 mmol/1 in 14 patients (82%) and 11 patients (64%) developed hypokalaemia. An increased osmolal clearance caused by a release of electrolyte and blast cell waste (i.e. urea, urate, etc.) during chemotherapy appeared to be the principle cause of natriuresis and hyperkaluria. Seven patients had proteinuria before and eight others developed it during antileukemic therapy. Nine patients (53%) developed proximal renal tubular dysfunction with aminoaciduria, hyperphosphaturia and incomplete reabsorption of urate. No significant relation was found between this widespread glomerulo-tubular dysfunction and lysozymuria. We suggest that antileukaemic drugs release unidentified substances from blast cells which are toxic to the kidney. Metabolic alkalosis in six patients (35%) was probably related to volume depletion and hypokalaemia, while two patients developed acidaemia with the onset of renal failure. Hypocalcemia in seven patients (41%) had a multifactorial basis: hyperphosphaturia, septicaemia, malnutrition and cytotoxic drugs were among the probable causes.
对17例未经挑选的急性髓系白血病患者进行了代谢平衡研究。观察到广泛的代谢紊乱。14例患者（82%）血清钠降至135 mmol/1以下，11例患者（64%）出现低钾血症。化疗期间电解质和原始细胞废物（即尿素、尿酸盐等）释放导致的渗透清除率增加似乎是钠尿症和高钾尿症的主要原因。7例患者在抗白血病治疗前有蛋白尿，另外8例在治疗期间出现蛋白尿。9例患者（53%）出现近端肾小管功能障碍，伴有氨基酸尿、高磷尿和尿酸盐重吸收不完全。未发现这种广泛的肾小球-肾小管功能障碍与溶菌酶尿之间存在显著关联。我们认为抗白血病药物从原始细胞中释放出对肾脏有毒的未知物质。6例患者（35%）的代谢性碱中毒可能与容量不足和低钾血症有关，而2例患者在肾衰竭发作时出现酸血症。7例患者（41%）的低钙血症有多种因素：高磷尿、败血症、营养不良和细胞毒性药物可能是原因之一。
