Patients with leukemia have a dramatic increase in the intracellular nucleic acid metabolite uric acid due to the massive destruction of leukemic cells during disease progression or during combination chemotherapy. The increased excretion of uric acid predisposes to the formation of urate crystals in the acidic environment of the renal tubules and blocks the tubules, resulting in obstructive renal damage called leukemic uric acid nephropathy.
In severe cases, this can lead to severe electrolyte disturbances such as hyperkalemia and acute renal failure, which can be life-threatening in severe cases.
Therefore, during chemotherapy for leukemia, especially in patients with high leukocytes and high tumor load, adequate hydration and alkalinization, monitoring of volume changes, diuresis, and administration of allopurinol to reduce uric acid production should be given before and at the same time as chemotherapy. For patients with severe renal impairment, dialysis is required.