肿瘤溶解综合征期间血清磷酸盐的过度升高:来自一个特别具有挑战性的病例的教训。

Clinical Nephrology. Case Studies Pub Date : 2021-04-16 eCollection Date: 2021-01-01 DOI:10.5414/CNCS110086
Prince K Amaechi, Fredrik Jenssen, Zipporah Krishnasami, Anand Achanti, Tibor Fülöp
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引用次数: 0

摘要

伯基特淋巴瘤是肿瘤溶解综合征(TLS)的常见病因,在预防性别嘌呤醇和重组尿酸酶积极应用的时代,肾病学家越来越多地看到单价或二价阳离子异常,但没有明显的尿酸升高。一名18岁男性患者接受了Burkitt淋巴瘤的第一周期强化化疗,并根据Cairo Bishop标准发展为TLS。乳酸脱氢酶峰值为9105 U/L(范围:130 ~ 250),伴有急性肾损伤,第4天血清肌酐为2.2 mg/dL,伴少尿、高钾血症、极端高磷血症(21.4 mg/dL)、高镁血症和低钙血症。肾脏替代治疗的决定是基于危及生命的电解质紊乱。有效控制高磷血症和避免透析不平衡综合征并发症的竞争必要性促使我们首先进行间歇血液透析,同时静脉注射甘露醇,然后进行持续血液透析,以管理细胞裂解中磷的持续产生。在治疗过程中,渗透稳定性得到了肯定的证明(分别为322、319 mOsm/kg)。患者对这些治疗表现出良好的耐受性,并在随访中最终恢复了肾功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Excessive elevation of serum phosphate during tumor lysis syndrome: Lessons from a particularly challenging case.

Burkitt's lymphoma is a common cause of tumor lysis syndrome (TLS) and, in the era of aggressive utilization of prophylactic allopurinol and recombinant uricase enzyme, nephrologists are increasingly witnessing monovalent or divalent cation abnormalities without marked uric acid elevation. An 18-year-old male received his 1st cycle of intensive chemotherapy for Burkitt's lymphoma and developed TLS as defined by the Cairo Bishop criteria. Lactate dehydrogenase peaked at 9,105 U/L (range: 130 - 250) and was accompanied by acute kidney injury, including serum creatinine 2.2 mg/dL on the 4th day with oliguria, hyperkalemia, extreme hyperphosphatemia (21.4 mg/dL), hypermagnesemia, and hypocalcemia. Renal replacement therapy decision was made based on life-threatening electrolyte disturbances. The competing necessity to effectively control hyperphosphatemia and avoid the complication of dialysis disequilibrium syndrome prompted us to perform an initial intermittent hemodialysis with simultaneous intravenous mannitol administration, followed by continuous hemodialysis to manage the continued production of phosphorus from cell lysis. Osmotic stability during the therapy session was affirmatively demonstrated (322, 319 mOsm/kg, respectively). The patient showed excellent tolerance for these therapies and eventually recovered renal function as demonstrated during follow-up visits.

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