ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2208

A Patient with Hyper-Warburgism Successfully Treated with Peritoneal Dialysis

Session Information

  • Onco-Nephrology - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Isaranuwatchai, Suramath, Chulabhorn Hospital, Bangkok, Thailand
  • Porntharukchareon, Thachanun, Chulabhorn Hospital, Bangkok, Thailand
  • Thookhamme, Chayapa, Chulabhorn Hospital, Bangkok, Thailand
Introduction

The combination of hypoglycemia and lactic acidosis in cancer patients is usually known as hyper-warburgism.

Case Description

A 74-year-old Thai man presented to our hospital with symptomatic hypoglycemia. He was previously healthy, no history of diabetes. Further investigation revealed hyperbilirubinemia, hepatosplenomegaly and first-diagnosed HIV infection. Computerized tomography of abdomen showed large liver mass with multiple intraabdominal lymphadenopathy. Liver mass biopsy showed round cell neoplasm with immunohistochemistry staining compatible with Burkitt lymphoma: positive for CD20, Bcl-6, CD10, C-myc, Ki67 100%, and negative for Bcl-2. His lymphoma was initially treated with high-dose dexamethasone. During investigation and initial treatment, our patient developed acute kidney injury (AKI) with severe lactic acidosis. Hypoglycemia persist even he received intravenous glucose 18 g/hour. Serum ketone, insulin and c-peptide were normal. We suspected that he had hyper-warburgism due to Burkitt lymphoma, which was not respond to dexamethasone. Due to HIV seropositive status, we chose automated peritoneal dialysis (PD) for AKI and severe metabolic acidosis in this patient. PD dose in this patient was 19 liters per day. After PD initiation, the patient gradually recovered, with serum lactate dramatically decreased and intravenous glucose could be stopped. Clinical and laboratory parameters, including major clinical events, were shown in figure 1. After lactic acidosis resolved, we decided to treat this patient with chemotherapy. Unfortunately, this patient died later due to fungemia, neutropenia and septic shock.

Discussion

Hypercatabolic state such as hyper-warburgism was usually treated with continuous renal replacement therapy (CRRT). Here, we presented a case of hyper-warburgism successfully treated with PD. We hoped this report might offer alternative treatment in patients who unable to undergo CRRT.

Figure 1: Clinical course of a patient with hyper-warburgism