Acute renal failure secondary to spontaneous acute tumor Lysis syndrome inmyelofibrosis

A 70-year-old man with myelofibrosis developed nonoliguric acute renal fail ure in association with acute uric acid nephropathy In the absence of chemo therapy or radiotherapy. The patient had an 18-month history of transfusion -dependent myelofibrosis and moderate chronic renal insufficiency. Admissio n laboratory findings were remarkable for severe hyperuricemia, hyperphosph atemia, hyperkalemia, and hypocalcemia with acute deterioration of renal fu nction, consistent with a diagnosis of acute uric acid nephropathy. Treatme nt, Including hemodialysis and allopurinol administration, resulted in clin ical Improvement with normalization of serum uric acid concentrations and r esolution of acute renal failure. With long-term allopurinol therapy, renal function has remained at his previous baseline, and there has been no tran sformation to acute leukemia. This case represents a rare Instance of acute renal failure related to the occurrence of acute uric acid nephropathy ass ociated with myelofibrosis and emphasizes the Importance of early recogniti on and aggressive management, which can lead to recovery of renal function. (C) 2001 by the National Kidney Foundation, Inc.