A CASE OF UNEXPLAINED RENAL FAILURE IN A YOUNG CHILD

Acute lymphoblastic leukemia (ALL) is a common pediatric malignancy, though its presentation with acute kidney injury (AKI) and spontaneous tumor lysis syndrome (TLS) is rare and presents significant clinical challenges. We report the case of a 10-year-old boy who presented with bilateral cervical lymphadenopathy, hypertension, and renal impairment. Initially treated conservatively at a local hospital, his condition deteriorated, leading to referral to our center. On further evaluation, the patient exhibited decreased urine output, weight loss, night sweats, and worsening renal function. Laboratory findings revealed AKI and hyperuricemia, raising suspicion of spontaneous TLS. Subsequent diagnostic workup, including bone marrow aspiration, biopsy, and flow cytometry, confirmed ALL with aleukemic features—characterized by the absence of circulating blasts in peripheral blood. The patient was managed with allopurinol, aggressive hydration, and, following hematology consultation, chemotherapy initiation at an oncological center. This case highlights the challenges in diagnosing and managing ALL with AKI and spontaneous TLS, emphasizing the importance of early recognition and multidisciplinary care to address rapidly progressing metabolic disturbances.