Severe hyperuricemia with acute kidney injury: Vigilance needed for spontaneous tumor lysis syndrome

Tumor lysis syndrome (TLS) is well described treatment related oncologic emergency with hyperuricemia being a cardinal sign of it leading to acute uric acid nephropathy. But spontaneous occurrence of TLS has occasionally been described in the literature. This spontaneous tumor lysis syndrome (STLS) is unusual cause for acute kidney injury (AKI) and a very uncommon initial presentation of lymphoma. AKI occurring in the setting of STLS has very poor outcome as it was not possible to institute preventive measures leading to very high mortality. We report a case of non-Hodgkin's lymphoma presenting with severe hyperuricemia with AKI. Our case stresses the importance of rapid diagnosis and treatment of AKI due to STLS which helps in early renal recovery. With prompt and timely initiation of hemodialysis and other supportive measures, renal failure and prognosis can be improved.