From the Guidelines
In a patient with high-grade lymphoma undergoing aggressive chemotherapy who shows an elevation in creatinine from 1 to 2.1, we would expect to see elevated uric acid levels (hyperuricemia). This occurs due to tumor lysis syndrome (TLS), a metabolic emergency that happens when large numbers of cancer cells die rapidly during treatment, releasing their contents into the bloodstream, as described in the guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review 1. The breakdown of cellular nucleic acids leads to increased uric acid production, which can precipitate in the kidneys and cause acute kidney injury.
Key Laboratory Findings
- Hyperuricemia: due to the rapid release of nucleic acids from lysed tumor cells, which are then catabolized to uric acid 1
- Hyperkalemia: resulting from the rapid release of potassium from lysed cells, which can be exacerbated by renal failure 1
- Hyperphosphatemia: also a consequence of cell lysis, leading to the release of intracellular phosphate into the bloodstream
- Hypocalcemia: can occur as a result of the hyperphosphatemia, as phosphate and calcium levels have an inverse relationship
Clinical Implications
The patient may also show elevated lactate dehydrogenase (LDH) levels, indicative of tissue damage, and metabolic acidosis, due to the accumulation of acidic byproducts of cellular metabolism. Potentially, there could be decreased urine output, signaling impaired renal function. Management typically includes aggressive hydration, allopurinol or rasburicase to reduce uric acid levels, and careful monitoring of electrolytes, as outlined in the guidelines for managing TLS 1. Early recognition and treatment of TLS are crucial to prevent further kidney damage and other serious complications in patients undergoing intensive chemotherapy for aggressive malignancies.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Expected Laboratory Findings
Given the elevation of creatinine from 1 to 2.1 in a 50-year-old male with high-grade lymphoma undergoing aggressive chemotherapy, we can expect other laboratory findings associated with tumor lysis syndrome (TLS). These include:
- Hyperuricemia: an elevation of uric acid levels in the blood 2
- Hyperphosphatemia: an increase in phosphate levels in the blood 2, 3
- Hypocalcemia: a decrease in calcium levels in the blood 2, 3
- Hyperkalemia: an increase in potassium levels in the blood 2, 3
Rationale
The expected laboratory findings are based on the definition of tumor lysis syndrome, which is characterized by the release of intracellular contents into the bloodstream due to the lysis of cancer cells. This can lead to an increase in uric acid, phosphate, and potassium levels, as well as a decrease in calcium levels.
Clinical Implications
The presence of these laboratory findings can have significant clinical implications, including the development of acute kidney injury (AKI) and other complications. Early recognition and management of TLS are crucial to prevent these complications and improve patient outcomes 2, 3.