A 24-year-old male presents to the ED with a few day history of increasing fatigue, weakness, malaise, nausea, edema, and oliguria. He has been diagnosed with acute lymphoblastic leukemia recently and is scheduled for chemotherapy next week. He has been on no medications and doing relatively well until the onset of the above-mentioned symptoms. His physical examination and lab studies are compatible with acute renal failure (mild) .
What is the most likely cause of his ARF?
What is the most appropriate initial treatment for his ARF?
What is the most likely cause of his ARF?
What is the most appropriate initial treatment for his ARF?
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コメント(3)
Hello, Kimdon sensei,
Another interesting case. The tricky part is chemo was not started yet. For Pre and post renal, my DD is the same as Yoshiroku-sensei. Especially with ALL, I would consider thromboembolism, just like Yoshiroku sensei mentioned as above.
For renal, sicne it is prior to chemo, I think TLS coudl be unlike, but like Yoshiroku-sesei mentioned as above, still is possible. I think in the real clinical setting, we would have more information. We would know what type of diagnosis work up he underwent for his recent dx of ALL would be the key. If he did CT with renal toxic contrast as a part of work up (for example to DD if it is ALL or lymphoma, or to check to see if his ALL has any tumor like presentation, which could contribute to ARF. He may also has leukemia infiltrate in his kidneys.
When a person like him comes to me, I would draw rainbow ( multi colored tubes), so I would know his phos, uric acid, calcium level as well. So depending on these levels, likely cause of his ARF could be narrowed down.
then can start allopurinol, alkalization urine or whatever depends on the findings suggests.
But first of all, like Yoshiroku-sensei mentioned, Foley needs to be placed sicne it would DD obstruction. Yoshirokusensei is very focused!!
I really like Medical doujou. I gotta go. I am almost late for my gym appt. let me know if any interesting tips for this case
Another interesting case. The tricky part is chemo was not started yet. For Pre and post renal, my DD is the same as Yoshiroku-sensei. Especially with ALL, I would consider thromboembolism, just like Yoshiroku sensei mentioned as above.
For renal, sicne it is prior to chemo, I think TLS coudl be unlike, but like Yoshiroku-sesei mentioned as above, still is possible. I think in the real clinical setting, we would have more information. We would know what type of diagnosis work up he underwent for his recent dx of ALL would be the key. If he did CT with renal toxic contrast as a part of work up (for example to DD if it is ALL or lymphoma, or to check to see if his ALL has any tumor like presentation, which could contribute to ARF. He may also has leukemia infiltrate in his kidneys.
When a person like him comes to me, I would draw rainbow ( multi colored tubes), so I would know his phos, uric acid, calcium level as well. So depending on these levels, likely cause of his ARF could be narrowed down.
then can start allopurinol, alkalization urine or whatever depends on the findings suggests.
But first of all, like Yoshiroku-sensei mentioned, Foley needs to be placed sicne it would DD obstruction. Yoshirokusensei is very focused!!
I really like Medical doujou. I gotta go. I am almost late for my gym appt. let me know if any interesting tips for this case
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