Kidney Week

Abstract: TH-PO543

Spontaneous Tumor Lysis Syndrome in Renal Solid Tumor: Case Report

Session Information

• Trainee Case Reports - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

• 103 AKI: Mechanisms

Authors

• Cesar, Bruno Nogueira, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Bruno Nogueira Cesar,

• Nunes, Nilo Eduardo delboni, Universidade Federal de Sao Paulo, São Paulo, Sao Paulo, Brazil

Nilo Eduardo delboni Nunes,

• Reghine, Erica Lofrano, Universidade Federal de Sao Paulo, São Paulo, Brazil

Erica Lofrano Reghine,

• Alves, Cicero rodrigo M., Universidade Federal de Sao Paulo, São Paulo, Brazil

Cicero rodrigo M. Alves,

• Foresto, Renato Demarchi, Universidade Federal de Sao Paulo, São Paulo, Brazil

Renato Demarchi Foresto,

• Hazin, Maria Amelia, Universidade Federal de Sao Paulo, São Paulo, Brazil

Maria Amelia Hazin,

• Durao, Marcelino Souza, Universidade Federal de Sao Paulo, São Paulo, Brazil

Marcelino Souza Durao,

Introduction

Tumor Lysis Syndrome (TLS) results from a large release of intracellular material from malignant cells death, especially after chemotherapy. Spontaneous TLS (STLS) is commonly associated with aggressive hematological malignancies and rarely observed in solid tumors.

Case Description

A 67-year- old male presented to the hospital with progressive dyspnea, weakness and oliguria in the last two days. His medical records were hypertension, diabetes, coronary heart disease and a recently diagnosed renal mass. Blood tests showed creatinine: 8.8 mg/dL, urea: 272mg/dL; potassium: 6.4 mEq/L; serum uric acid: 15.9 mg/dL; phosphate: 7.6 mg/dL; ionic calcium: 1.07mmol/L. Two months before, creatinine level was 1.0 mg/dL. Abdominal and renal doppler ultrasound were performed and showed normal sized kidneys with a hypoechoic image on the left side, without signs of thrombosis. Abdominal CT scan showed a Bosniak-III left expansive kidney lesion. According to the clinical and laboratory findings, STLS diagnosis was performed. Due to a lack of response to conservative measures, hemodialysis was initiated and after three sessions kidney function improved and dialysis was discontinued. The patient underwent left nephrectomy. Histological analysis showed a clear cell renal cell carcinoma Fuhrman 3, stage T3a, with recent evidences of hemorrhage and tumor necrosis. The disease was restricted to kidney tissue. The patient was discharged from the hospital on the 5^th post-operative day. At this time, blood tests showed creatinine was 1.6mg/dL, potassium 5 mEq/L, phosphate: 5.8 mg/dL, ionic calcium: 1.2 mmol/L and uric acid: 4 mg/dL.

Discussion

STLS is a serious event that affects patients with cancer. There are few reports of its association with solid tumors, especially in the case of renal cell carcinomas. In this report, the diagnosis of STLS was performed using the Cairo-Bishop criteria and was classified as grade 4. In most reported cases, larger masses with metastases prevailed and the patient died immediately after diagnosis. Physicians should be aware of the diagnosis since it requires prompt actions to improve outcomes.