“A 22-year-old male with Burkitt lymphoma arrives at oncology day care with acute abdominal pain, nausea, vomiting, and confusion shortly after starting R-CODOX-M (rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate). His vitals are BP 90/67 mmHg, HR 121/min, SpO2 95% on room air, and respiratory rate 25/min. Venous blood gas analysis shows: pH 7.23, PCO2 26 mmoL/L, HCO3 17 mmoL/L, Lactate 2.24 mmoL/L. Laboratory tests reveal the following:
Wrong Answer:A. Hyperphosphatemia-induced AKI
Wrong Answer:B. Obstructive uropathy
Right Answer: C. Uric acid nephropathy
Explanation: In this scenario, the patient is likely experiencing uric acid nephropathy (Option C), which is a common complication of Tumour Lysis Syndrome (TLS) in patients with rapidly proliferating tumors such as Burkitt lymphoma. Despite treatment with rasburicase (which helps to reduce uric acid levels), the high serum uric acid indicates that uric acid crystals have precipitated in the renal tubules, leading to obstructive nephropathy and subsequent acute kidney injury. Hyperphosphatemia (Option A) can contribute to kidney injury, but given the high level of uric acid and the patient's anuric state, uric acid nephropathy is more likely. Enlarged lymph nodes in Burkitt’s lymphoma can compress the urinary tract, causing obstructive uropathy ((Option B) and reduced urine output, though anuria is unlikely. This should be considered if tumor lysis is ruled out. An ultrasound of the urinary tract is essential to confirm this. Sepsis (option D) is a frequent complication in patients with high-grade hematological malignancies like Burkitt's lymphoma, potentially resulting in multi-organ dysfunction, including acute kidney injury. However, the clinical indicators provided (high WBC, low platelets, and high lactate) are insufficient to confirm sepsis. Biomarkers (Such as S-reactive protein and procalcitonin), imaging (such as chest X-rays, CT scans, or ultrasounds to identify infection sources like pneumonia or abscesses), and body fluid cultures are necessary to rule out sepsis.
Wrong Answer: D. Sepsis-induced AKI
