Pretreatment Tumor Lysis Syndrome Associated with Bulky Retroperitoneal Tumors. Recognition is the Mainstay of Therapy

Acute pretreatment tumor lysis syndrome is a rare complication of cancer. Early recognition and aggressive management are mandatory for prevention of the adverse sequelae of the syndrome. Here we present 2 cases of pretreatment tumor lysis syndrome, concluding that this clinical entity should be in the differential diagnosis of acute renal failure associated with malignancy, as early recognition is in fact the mainstay of treatment.

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Continuous Hemodiafiltration in Children

PEDIATRICS ◽

10.1542/peds.85.5.819 ◽

1990 ◽

Vol 85 (5) ◽

pp. 819-823

Author(s):

Nancy A. Bishof ◽

Thomas R. Welch ◽

C. Frederic Strife ◽

Frederick C. Ryckman

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Effective Means ◽

Tumor Lysis Syndrome ◽

Intermittent Hemodialysis ◽

Tumor Lysis ◽

Continuous Arteriovenous Hemofiltration

Continuous arteriovenous hemofiltration is a form of renal replacement therapy whereby small molecular weight solutes and water are removed from the blood via convection, alleviating fluid overload and, to a degree, azotemia. It has been used in many adults and several children. However, in patients with multisystem organ dysfunction and acute renal failure, continuous arteriovenous hemofiltration alone may not be sufficient for control of azotemia; intermittent hemodialysis or peritoneal dialysis may be undesirable in such unstable patients. Recently, the technique of continuous arteriovenous hemodiafiltration has been used in many severely ill adults. We have used continuous arteriovenous hemodiafiltration in four patients at Children's Hospital Medical Center. Patient 1 suffered perinatal asphyxia and oliguria while on extracorporeal membrane oxygenation. Patients 2 and 4 both had Burkitt lymphoma and tumor lysis syndrome. Patient 3 had septic shock several months after a bone marrow transplant. All had acute renal failure and contraindications to hemodialysis or peritoneal dialysis. A blood pump was used in three of the four patients, while spontaneous arterial flow was adequate in one. Continuous arteriovenous hemodiafiltration was performed for varying lengths of time, from 11 hours to 7 days. No patient had worsening of cardiovascular status or required increased pressor support during continuous arteriovenous hemodiafiltration. The two survivors (patients 2 and 4) eventually recovered normal renal function. Continuous arteriovenous hemodiafiltration is a safe and effective means of renal replacement therapy in the critically ill child. It may be ideal for control of the metabolic and electrolyte abnormalities of the tumor lysis syndrome.

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Alcohol Related Non-traumatic Rhabdomyolysis and Compartment Syndrome

Acute Medicine Journal ◽

10.52964/amja.0152 ◽

2007 ◽

Vol 6 (1) ◽

pp. 33-34

Author(s):

JPL Ong ◽

◽

LA Thomas ◽

Keyword(s):

Skeletal Muscle ◽

Renal Failure ◽

Acute Renal Failure ◽

Lower Extremity ◽

Compartment Syndrome ◽

Early Recognition ◽

Clinical Entity ◽

Threatening Condition ◽

Life Threatening ◽

Renal Support

Rhabdomyolysis is a serious and life-threatening condition in which skeletal muscle is damaged, commonly resulting in acute renal failure. The causes of this clinical entity can be traumatic and non-traumatic. In the latter group, alcohol is the commonest cause. This report describes the case of a 25 year old man who presented with rhabdomyolysis leading to acute renal failure after an alcohol binge. He presented with painful legs and lower extremity compartment syndrome. The patient recovered with surgical fasciotomy and renal support. This case illustrates the importance of early recognition and treatment of alcohol related non-traumatic rhabdomyolysis and compartment syndrome.

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