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.