Hyperuricemic Renal Failure in Nonhematologic Solid Tumors: A Case Report and Review of the Literature

Table 1

Published Case reports of spontaneous tumor lysis syndrome in solid non-hematologic tumors published in the literature.

Age sex	Type of cancer	Primary site	Tumour burden and metastases	Lab values*		Treatment	Outcome
13, F [4]	Germ cell tumor–pure germinoma	Pineal and suprasellar mass	20×17×13 cm pelvic mass with numerous peritoneal deposits	LDH	2310	Rasburicase with hydration Platinum-based chemotherapy given.	Survived
				Uric acid	28
				K; Ca; Ph	5.6; 7.2; 7.3
				Creat	3.3
22, M [5]	Germ cell tumour–choriocarcinoma	Testis	Retroperitoneal mass of 14 cm in diameter with massive Liver and Lung metastases and numerous lymph nodes	LDH	4055	Hydration and rasburicase	Died
				Uric acid	18
				K; Ca; Ph	7.2; 9.6; 7.2
				Creat	4.5
53, M [6]	Squamous cell Carcinoma	Maxillary Sinus	2.8×2.2×2 cm papilloma in maxillary sinus with extensive metastases in liver	LDH	1000	Hydration; urinary alkalization with allopurinol and rasburicase	Died
				Uric acid	20.9
				K; Ca; Ph	7.6; 6.2; 11.8
				Creat	6.4
74, M [7]	Squamous cell carcinoma	Lung	Stage 4	LDH	N/a	Hydration; uricolytic therapy with hemodialysis	Survived
				Uric acid	15.4
				K; Ca; Ph	5.2; n/a; 4.7
				Creat	4.7
72, M [8]	Prostate carcinoma	Prostate	Extensive liver metastases and bone metastases	LDH	1288	Hydration; allopurinol, and daily hemodialysis	Died
				Uric acid	28.1
				K; Ca; Ph	4.9; 8.0; 8.3
				Creat	6.1
82, F [9]	Colon carcinoma	Colon	Multiple large nonhomogenous liver masses with necrosis	LDH	2304	Hydration, alkalization, and allopurinol	Survived
				Uric acid	20.4
				K; Ca; Ph	n/a; 5.7; 5,5
				Creat	3.5
80, M [9]	Pheochromocytoma	Adrenal glands	20 cm diameter mass on adrenal glands with central necrosis	LDH	964	Hydration, alkalization, and allopurinol	Survived
				Uric acid	16.5
				K; Ca; Ph	6.6; 8.4; 5.8
				Creat	2.8
72, M [9]	Hepatocellular carcinoma	Liver	n/a	LDH	1024	Hydration, alkalization, and allopurinol	Died
				Uric acid	20.1
				K; Ca; Ph	4.5; 7.2; 5.4
				Creat	3.2
52, M [10]	Germ cell tumor–endodermal Sinus tumor	n/a	Bulky para-aortic lymphadenopathy with liver and lung mets with necrotic tissue	LDH	13400	Hemodialysis and chemotherapy initiated	Survived but died 4 months later
				Uric acid	21.8
				K; Ca; Ph	7.9; 5.0; 7.1
				Creat	4.19
24, M [10]	Germ cell tumor–seminoma	Testis	20×25 cm retroperitoneal mass with liver metastases	LDH	13070	Hemodialysis with chemotherapy initiated. Later surgical removal of residual mass	Survived
				Uric acid	24
				K; Ca; Ph	8.5; 7.6; 10
				Creat	5.06
50, M [11]	Metastatic adenocarcinoma of unknown primary	Unknown primary	Extensive tumor nodules in the liver with liver extending 17 cms below the costal margin with bulky lymphadenopathy and vertebral metastasis	LDH	n/a	Hydration with alkalization and allopurinol	Died
				Uric acid	37
				K; Ca; Ph	6.5; 8.3; 9.2
				Creat	4.7
62, F [12]	Inflammatory breast cancer–lobular carcinoma	Breast	Large breast mass and supraclavicular lymphadenopathy with multiple mets in bones, lung, liver, and bone marrow	LDH	509	Allopurinol and chemotherapy initiated	Survived but died of recurrence 16 months later
				Uric acid	10.1
				K; Ca; Ph	n/a; 10.1; 6.0
				Creat	0.9
36, M [13]	Gastric cancer adenocarcinoma	Stomach	Huge mass of more than 7 cm with multiple hepatic mets and lymphadenopathies	LDH	13924	Hydration, alkalization, allopurinol, hemodialysis, and chemotherapy initiated	Died
				Uric acid	16.9
				K; Ca; Ph	5.6; 7.0; 6.9
				Creat	2.9
72, M [14]	Lung cancer adenocarcinoma	Lung	Large left upper lobe mass with multiple liver mets	LDH	1016	Hydration, potassium and phosphate binders, calcium gluconate, and allopurinol	Died
				Uric acid	12.65
				K; Ca; Ph	7.0; 8.2; 8.3
				Creat	1.28

*Lab values are given as mg/dL for uric acid, serum creatinine, Potassium, Calcium and Phosphate and as IU/mL for LDH.