Continuous veno-venous hemodiafiltration for the treatment of spontaneous tumor lysis syndrome complicated by acute renal failure and severe hyperuricemia

We describe a case of Burkitt's lymphoma presenting as spontaneous tumor ly sis syndrome (TLS) complicated by severe hyperuricemia and anuric acute ren al failure presumed to be secondary to uric acid nephropathy. The patient w as treated with continuous veno-venous hemodiafiltration (CVVHDF) using a d ialysate flow rate of 2.5 l/h, and a replacement fluid rate of 1.5 l/h (adm inistered in pre-dilution). Mean clearances during CVVHDF for urea, creatin ine, uric acid, and phosphorus were, respectively, 55.8 +/- 3.8, 48.9 +/- 2 .6, 45.1 +/- 2.6 and 47.0 +/- 3.3 ml/min (or 80, 70, 65 and 68 l/day, respe ctively). Serum urea, creatinine, uric acid, and phosphorus decreased from 42 to 9 mmol/l, 533 to 189 mu mol/l, 1980 to 372 mu mol/l, and 2.0 to 1.4 m mol/l, respectively, after 48 hours of CVVHDF. Previously, we reported the use of continuous arteriovenous hemodialysis (CAVHD) at a high dialysate fl ow rate of 4 l/h for the treatment of acute renal failure and TLS, which pr ovided excellent continuous clearances of small molecular weight solutes. T his last modality was very efficient and prevented deleterious rebound in s erum solute concentrations frequently observed in TLS after intermittent he modialysis (IHD). It was concluded that high-dialysate flow rate CAVHD was a more potent form of treatment than conventional IHD. With recent advances in technology, veno-venous continuous renal replacement therapies are beco ming more popular than arterio-venous modalities since they are safer and l ess cumbersome. Furthermore, flow rates being precisely regulated, solute c learances can be steadily maintained. With CVVHDF flow rates as used in thi s report, we achieved excellent solute clearances and metabolic control. We propose CVVHDF as an ideal treatment for acute renal failure in TLS. In ou r opinion, CVVHDF is an advantageous alternative to treat TLS complicated b y acute renal failure.