Acute renal failure as an initial manifestation of acute lymphoblastic leukemia
A 13-year-old boy presented with bilateral swelling in the neck for one week, cough, dyspnea, and reduced urine output for 3 days. Physical examination showed cervical lymphadenopathy and hepatosplenomegaly. He was found to have hypertension, which was controlled with nifedipine. Investigations revealed hemoglobin of 5 g/dl; white blood cell count 300,100/cumm; platelet count 75,000/cumm; uric acid 32.2 mg/dl; LDH 12,720 U/L; and peripheral smear showed 90% blast cells. Renal functions showed BUN 38 mg/dl and creatinine 2.4 mg/dl; urine analysis was normal. Serum electrolytes and arterial blood gas analysis were normal. Renal ultrasound was normal. Bone marrow biopsy and flow cytometry showed features suggestive of ALL (T-cell type). He was started on dialysis, chemotherapy, and tumor lysis supportive measures. Renal parameters normalized after 2 weeks, indicating again the possibility of uric acid nephropathy. Currently he is on chemotherapy.\nA renal biopsy was not performed in our patients as there was complete resolution of renal failure and a definite diagnosis of leukemia was obtained.