A case of ALL with Massively Enlarged Kidneys at Dignosis and Complicated with Tumor Lytic Syndrome, Diabetes Mellitus and Pancreatitis while Remission Induction

Abstract

A 12 year-old girl having common acute lymphoblastic leukemia and impairment of renal function at diagnosis was found to have massively enlarged kidneys. The kidneys dramatically decreased in size after initiation of induction chemotherapy as well as local irradiation to one side of kidneys. As a consequence of rapid leukemic cell lysis, hyperuricemia, hyperphosphatemia and hypocalcemia associated with elevation of serum BUN and creatinine occurred. The clinical course of the patient was further complicated with acute pancreatitis, diabetes mellitus and fungemia which were successfully managed. The patient finally obtained complete remission in 4 weeks and remains in continuous complete remission 23 months after diagnosis.
We would like to discuss about the role of local irradiation and systemic chemotherapy for the patient with leukemia who present with enlarged kidneys and abnormal renal function.