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Albuminuric chronic kidney disease — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Albuminuric chronic kidney diseaseUSMLE Step 3

A 16-year-old with bulky Burkitt lymphoma is about to start cytotoxic therapy. Uric acid is 9.8 mg/dL, LDH is four times the upper limit of normal, kidney function is preserved, and quantitative testing confirms severe G6PD deficiency. Which tumor-lysis prevention plan is most appropriate?

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Correct answer: A — Give intravenous hydration plus allopurinol; omit rasburicase and monitor electrolytes closely

The best answer is “Give intravenous hydration plus allopurinol; omit rasburicase and monitor electrolytes closely”. Burkitt lymphoma with bulky disease and marked LDH creates high tumor-lysis risk, but rasburicase is contraindicated in G6PD deficiency because it can cause severe hemolysis and methemoglobinemia. NCI guidance supports hyperhydration with allopurinol when rasburicase cannot be used, together with frequent potassium, phosphate, calcium, uric-acid, and kidney-function monitoring.

Reference: NCI PDQ: Childhood Non-Hodgkin Lymphoma Treatment—Tumor Lysis Syndrome: https://www.cancer.gov/types/lymphoma/hp/child-nhl-treatment-pdq