Post-cytokine-release Salt Wasting as Inverse Tumor Lysis Syndrome in a Non-cerebral Natural Killer-cell Neoplasm

Intern Med. 2017;56(14):1855-1861. doi: 10.2169/internalmedicine.56.8125. Epub 2017 Jul 15.

Abstract

The pathogenesis of cerebral/renal salt-wasting syndrome remains unknown. We herein present a case of salt-wasting syndrome with a natural killer-cell neoplasm without cerebral invasion. A 78-year-old man with hemophagocytic syndrome received two cycles of chemotherapy that did not induce tumor lysis syndrome, but repeatedly caused polyuria and natriuresis. The expression of tumor necrosis factor-α in the neoplasm led us to hypothesize that an oncolysis-induced cytokine storm may have caused renal tubular damage and salt wasting. Our theory may explain the pathogenic mechanism of cerebral/renal salt-wasting syndrome associated with other entities, including cerebral disorders, owing to the elevation of cytokine levels after subarachnoid hemorrhage.

Keywords: cerebral salt wasting syndrome; pathogenesis; pathophysiology; renal salt wasting syndrome; tumor necrosis factor-alpha.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cytokines / metabolism
  • Humans
  • Hyponatremia / chemically induced
  • Inappropriate ADH Syndrome / chemically induced*
  • Leukemia, Large Granular Lymphocytic / drug therapy*
  • Male
  • Natriuresis
  • Polyuria / chemically induced
  • Tumor Lysis Syndrome / physiopathology

Substances

  • Cytokines