Case Report
Spontaneous Tumor Lysis Syndrome in Renal Cell Carcinoma: A Case Report

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Introduction

Tumor lysis syndrome (TLS) is a condition that might occur after the treatment of a malignancy. It results from the rapid necrosis of tumor cells resulting in multiple metabolic abnormalities (hyperphosphatemia, hypocalcemia, hyperkalemia, and hyperuricemia) and clinical complications; however, it can also occur spontaneously and should be recognized in a timely manner and aggressively treated. The most commonly used classification for TLS, the Cairo-Bishop definition, was proposed in 2004.1 At least 2 laboratory criteria must be present for 3 days before treatment or up to 7 days after treatment (Table 1).

Spontaneous TLS (STLS) has been well documented and recognized in multiple hematologic malignancies, mostly in aggressive non-Hodgkin lymphomas and acute leukemias.2, 3, 4 The incidence of STLS in patients with solid tumors is unknown, but it is believed to be extremely rare. Our search of the PubMed database for STLS in solid tumors revealed < 20 case reports, most of which have been reported within the past 10 years. We were not able to find any case report of STLS in metastatic kidney cancer.

Renal cell carcinoma is considered to be a relatively common malignancy with incidence varying greatly between races, sexes, geographic locations, and ages. In the United States alone, there is an average of 64,000 new cases diagnosed each year.5 It is the most common type of kidney cancer in adults, responsible for approximately 90% to 95% of cases.6 In this article, we discuss the first ever reported case of STLS due to a renal cell carcinoma.

Section snippets

Case Report

Our patient was a 56-year-old Caucasian man with a medical history of hypertension who was in his usual state of health when he presented to his local hospital with hematuria. The initial work-up was nonconclusive including normal blood work, negative cystoscopy and urine cytology. Because of persistent hematuria, a repeated cystouretheroscopy was performed. A biopsy revealed a noninvasive low-grade papillary urothelial neoplasm. He underwent a renal scan that revealed a large left mid-to-lower

Discussion

Our patient was relatively asymptomatic at presentation; however he met the clinical diagnosis of TLS (1 clinical symptom in addition to 2 laboratory criteria) based on his acute renal failure, hyperphosphatemia, and hyperuricemia. His diagnosis was recognized very quickly and he was treated with appropriate supportive measures including aggressive intravenous hydration, allopurinol, and hemodialysis. Unfortunately, because of extensive metastatic disease, he developed irreversible multiorgan

Conclusion

STLS is a medical emergency that has become more frequently reported as a complication of solid tumors. The current risk stratification guidelines do not address prophylaxis in either hematologic or nonhematologic tumors susceptible to developing STLS. Screening with uric acid and LDH in patients with highly aggressive malignancies could help identify those who would benefit from prophylactic treatments. STLS should be entertained in the differential diagnosis of patients with advanced

Disclosure

The authors have stated that they have no conflicts of interest.

Acknowledgments

Verbal consent was obtained from the patient's wife and son.

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