Acute renal failure with hyperuricemia as initial presentation of leukemia in children

We report on two children who presented with hyperuricemia and acute renal failure (admission uric acid levels 57.4 and 59.2 mg/dl).

Both were subsequently diagnosed to have acute lymphoblastic leukemia, despite normal initial complete blood counts and peripheral smear. Neither patient had nephromegaly on renal ultrasound.

Hyperuricemia and acute renal failure, particularly if recurrent, may be an early presentation of childhood leukemia and should lead to a bone marrow aspirate/biopsy.