Hyperuricemia complicating leukemia: treatment with allopurinol and dialysis

Abstract

Hyperuricemia is a known, potentially fatal complication of leukemia, particularly following therapy of the acute process. Hydration, solute diuresis, and alkalinization of the urine often are sufficient to allow the kidneys to excrete the increased load of uric acid.¹Despite this therapy, uric acid crystallization may occur which can be relieved by cystoscopy and alkali lavage of the renal pelvis. Severe hyperuricemia causing urate crystallization and anuria may require therapy with dialysis.^1-5This complication of leukemia and lymphoma is best treated by a prevention of uric acid synthesis using the xanthine oxidase inhibitor, allopurinol, as described by Rundles and associates.⁶Unfortunately, acute leukemia often is abrupt in its onset of exacerbations, and hyperuricemia may be an early manifestation. The patient to be described is the first example in whom neither dialysis nor allopurinol alone were sufficient to alleviate the hyperuricemia, but combined therapy corrected the hyperuricemia, restored