A case of renal replacement therapy for hyperphosphatemia associated with tumor lysis syndrome for B-cell precursor acute lymphoblastic leukemia

Abstract

Tumor lysis syndrome (TLS) is recognized as an oncologic emergency because of its potential to cause electrolyte imbalance and multiple organ failure. Renal replacement therapy (RRT) is implemented in patients with advanced TLS that are resistant to medications. RRT is categorized as a renal indication for the direct treatment of AKI and non-renal indication for the removal of substances involved in the disease. We report the case of a 14-year-old boy with B-cell precursor acute lymphoblastic leukemia who developed rapid hyperphosphatemia and secondary hypocalcemia leading to arrhythmia and hypotension due to TLS, four days after initiating steroid therapy. By introducing RRT to correct electrocyte balance, leukemia treatment was continued safely. Hyperphosphatemia associated with TLS and secondary hypocalcemia can cause cardiac dysfunction; thus, RRT should be considered, even in the absence of renal dysfunction.