Veenstra J, Krediet R T, Somers R, Arisz L
Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands.
Neth J Med. 1994 Nov;45(5):211-6.
Two patients with Burkitt's lymphoma and acute renal failure are described, one with acute uric acid nephropathy and the other with acute renal failure due to hyperphosphataemia. Renal insufficiency caused by the precipitation of calcium phosphate salts only occurs after starting treatment of the lymphoma; uric acid nephropathy can also be present in an untreated patient. A uric acid/creatinine ratio in a random urine sample may help to confirm the diagnosis of acute uric acid nephropathy. Vigorous hydration, allopurinol and alkalinization of the urine have been advocated to prevent uric acid nephropathy. However, alkalinization may accelerate phosphate precipitation in the kidneys and thereby induce renal failure. Xanthine nephropathy may develop as a consequence of high doses of allopurinol. The administration of large volumes of fluid therefore remains the keystone in prevention of the tumour lysis syndrome.
本文描述了两名患有伯基特淋巴瘤和急性肾衰竭的患者，其中一名患有急性尿酸肾病，另一名因高磷血症导致急性肾衰竭。磷酸钙盐沉淀引起的肾功能不全仅在淋巴瘤治疗开始后出现；尿酸肾病也可能出现在未经治疗的患者中。随机尿样中的尿酸/肌酐比值可能有助于确诊急性尿酸肾病。有人主张积极补液、使用别嘌醇和尿液碱化来预防尿酸肾病。然而，碱化可能会加速肾脏中磷酸盐的沉淀，从而诱发肾衰竭。高剂量别嘌醇可能会导致黄嘌呤肾病。因此，大量补液仍然是预防肿瘤溶解综合征的关键。
