Abstract: PUB028
Hyperuricemia with Urate Nephropathy in the Setting of Leukemoid Reaction: A Case Report
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Dweekat, Mo'tasem Zuhier (M. R.), University Hospitals Health System, Cleveland, Ohio, United States
- Zhao, Jinhua, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
Introduction
Urate nephropathy related to tumor lysis syndrome (TLS) is well described. It is also common in patients with gout. Urate nephropathy unrelated to either condition is rare. Here we report a case of urate nephropathy in a patient with multiple abscesses and leukemoid reaction.
Case Description
A 71-year-old male with past history of obesity, and a recent diagnosis of type II Diabetes was admitted with multiple staph aureus skin abscesses, leukocytosis as well as renal impairment. Baseline kidney function was unknown due to absence of medical follow up. Initial workup revealed Serum Cr of 2.9 mg/dL, sustained severe leukocytosis with a peak of 58.6 x 103cells/mm3 and serum uric acid (UA) of 15 mg/dl. He had no history of gout. With suspicion of a hematologic disease, relatively bland urinalysis, the massive amount of UA crystals seen on urine microscopy shown in the figure, as well as absence of other explanation for the renal impairment, urate nephropathy was suspected and Rasburicase was administered. Serum Cr normalized within days. Following discharge, the patient was diagnosed with CMML-1 with a bone marrow aspiration & biopsy. Despite receiving no treatment for CMML-1, renal function remains normal.
Discussion
CMML has a well reported association with hyperuricemia, but our patient received no treatment for the disease. His WBC count decreased to the normal range following 3 weeks of antibiotics. His UA level & WBC count remain within normal limits several months later. Thus, hyperuricemia and acute urate nephropathy were likely related to the leukemoid reaction. We report this case to emphasize the importance of urine microscopy and to call for consideration of leukemoid reaction as a possible cause for hyperuricemia.