Renal Case: 47-year-old Woman with Non-Hodgkin's Lymphoma

00:01 So let's move on to our next case.

00:03 You're asked to see a 47-year-old woman who has a history of Non-Hodgkin's lymphoma.

00:08 Her tumor is high grade but very responsive to chemotherapy.

00:12 She underwent her first cycle 2 days prior and is now admitted with hyperkalemia and decreased urine output.

00:19 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.

00:35 And interestingly, on her urine analysis, there are uric acid crystals.

00:41 So what type of acute kidney injury does this woman have? Let's go through our clinical case in order to find the answer.

00:49 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.

00:57 Along with that high potassium and uric acid, that's really suggestive of acute tubular obstruction from uric acid or tumor lysis syndrome.

01:04 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.

01:22 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.

01:32 And finally, on that urine analysis, that's really helpful to see things like uric acid crystals.

01:38 Again, being very suggestive of acute tubular obstruction from uric acid.

01:43 And in this situation, the answer to our question is that she does have acute tubular obstruction due to tumor lysis syndrome.