So let's move on to our next case.
You're asked to see a 47-year-old woman who
has a history of Non-Hodgkin's lymphoma.
Her tumor is high grade but very
responsive to chemotherapy.
She underwent her first cycle 2 days
prior and is now admitted with hyperkalemia
and decreased urine output.
On physical exam, it's relatively unremarkable but her
serum creatinine on her labs is now elevated to 4.2 (mg/dL),
so you can see that that's highly elevated,
her potassium is high at 5.9 (mEq/L),
phosphorus and uric acid are also very high.
And interestingly, on her urine
analysis, there are uric acid crystals.
So what type of acute kidney
injury does this woman have?
Let's go through our clinical
case in order to find the answer.
So I think what's very important in the history
is that we can see this temporal correlation
between the administration
of chemotherapy and her AKI.
Along with that high potassium
and uric acid, that's really suggestive
of acute tubular obstruction from
uric acid or tumor lysis syndrome.
And essentially, what happens is
that tumors are so chemo-sensitive
that when chemotherapy's administered,
it's like liquid, just all of those cells liquefy
and they have intracellular release
of these contents into the circulation
We can also see that patients are
typically oliguric in this setting.
Think about what's happening,
we've got obstructive tubules here
so it's not uncommon for patients to have a decrease
in urine output often to the oliguric level.
And finally, on that urine analysis, that's really
helpful to see things like uric acid crystals.
Again, being very suggestive of acute
tubular obstruction from uric acid.
And in this situation, the
answer to our question is that
she does have acute tubular obstruction
due to tumor lysis syndrome.