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Massive hyperphosphatemia in clinical tumor lysis syndrome during prophylactic rasburicase use: risk factors and treatment options

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Abstract

We report the case of a 76-year-old female with diffuse large B cell lymphoma who developed tumor lysis syndrome (TLS) and subsequent acute kidney injury (AKI) due to massive hyperphosphatemia during the prophylactic use of rasburicase. Our case showed no hyperphosphatemia before chemotherapy but had elevated uric acid and creatinine levels and unilateral hydronephrosis due to paraaortic lymphadenopathy. TLS risk was classified as high risk because of bulky mass, LDH elevation, and renal disturbance. With rasburicase use, uric acid was completely controlled but massive hyperphosphatemia and, subsequently, AKI developed. Immediate kidney replacement therapy led to improvement of hyperphosphatemia and AKI. In the rasburicase era, hyperphosphatemia has been a key target for preventing and treating TLS. Renal replacement therapy is the only effective option for lowering hyperphosphatemia and treating AKI.

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Authors and Affiliations

  1. Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152, Japan

    Shohei Kikuchi, Makiko Muro, Yusuke Kamihara, Akinori Wada, Yoshimi Nabe, Tomoki Minemura & Tsutomu Sato

  2. Center for Medical Residency Training, Toyama University Hospital, Toyama, Japan

    Makiko Muro

  3. Division of Transfusion Medicine and Cell Therapy, Toyama University Hospital, Toyama, Japan

    Jun Murakami

Authors
  1. Shohei Kikuchi
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  2. Makiko Muro
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  3. Yusuke Kamihara
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  4. Akinori Wada
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  5. Jun Murakami
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  6. Yoshimi Nabe
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  7. Tomoki Minemura
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  8. Tsutomu Sato
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Contributions

SK and MM collected data and drafted the manuscript. SK, YK, AW and TS were physicians providing chemotherapy. All authors reviewed the manuscript. TS supervised the study.

Corresponding author

Correspondence to Tsutomu Sato.

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Kikuchi, S., Muro, M., Kamihara, Y. et al. Massive hyperphosphatemia in clinical tumor lysis syndrome during prophylactic rasburicase use: risk factors and treatment options. Int Canc Conf J 12, 69–74 (2023). https://doi.org/10.1007/s13691-022-00580-9

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  • DOI: https://doi.org/10.1007/s13691-022-00580-9

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