Author: Joshua Schwimmer, M.D., FACP, FASN
Reviewer: V. Dimov, M.D.
A 65-year-old man with previously normal renal function had a few days of poor appetite and is found to have a creatinine of 4 mg/dL and widespreadlymphadenopathy suspicious for lymphoma or leukemia.
Urinalysis shows no proteinuria or hematuria. His renal function worsens despite intravenous fluids.
What are the top four possible causes of his kidney failure?
1. Acute tubular necrosis due to decreased intake
2. Urinary tract obstruction due to retroperitoneal lymphadenopathy
3. Lymphomatous infiltration of the kidneys
4. Spontaneous tumor lysis syndrome and uric acid nephropathy
Answer: (highlight the line below with the mouse to see the answer)
4. Spontaneous tumor lysis syndrome and uric acid nephropathy.
His uric acid was 20, and he responded well to rasburicase. There was not any hematuria or proteinuria, which reduces the likelihood of other causes, like bilateral renal vein thrombosis and minimal change disease with acute renal failure.