Acute Renal Failure at Onset of Therapy for Advanced Stage Burkitt Lymphoma and B Cell Acute Lymphoblastic Lymphoma

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Abstract
Aggressive therapeutic maneuvers to reduce the risk for acute renal failure are routine in the management of children receiving therapy for advanced stage Burkitt lymphoma and B cell acute lymphoblastic leukemia. The case histories of 40 children entered into a prospective treatment protocol for high-risk disease revealed that ten of 40 patients (25%) had acute renal failure, two at the time of hospital admission and eight in whom renal insufficiency developed 12 to 132 hours following initiation of cytotoxic chemotherapy. Admission values for serum lactic dehydrogenase and serum uric acid were not statistically different between patients with and without subsequent renal failure. Urine output in the 12 hours prior to antineoplastic therapy was 2.9 .+-. 0.8 mL/kg/h in the eight children in whom renal failure developed and 5.3 .+-. 0.4 mL/kg/h in the patients who did not (P < .01). The urinary flow rate in the 24 hours following initiation of chemotherapy was significantly lower in children in whom renal impairment developed (1.0 .+-. 0.2 mL/kg/ha, mean .+-. SE) compared with those who did not (3.7 .+-. 0.3 mL/kg/h, P < .001). Renal failure could not be attributed to hyperuricemia or hyperphosphatemia in the majority of patients with renal failure. One to four hemodialysis treatments (2.5 .+-. 0.3) were required for the ten patients. Serum creatinine concentrations returned to normal in the nine survivors. Response to initial antineoplastic therapy was not affected by the presence of renal failure. Renal failure continues to be a major clinical problem in children with Burkitt lymphoma and B cell lymphoblastic leukemia. Oliguria during initial fluid management should alert physicians to patients who may require dialysis during induction chemotherapy.