Uric acid blood and urine studies were performed in 12 patients with lymphomas while on a measured low purine diet before, during and after cytotoxic therapy.
Before treatment, urinary uric acid excretion in these patients was significantly higher than in normal subjects, although only 2 patients had clearly elevated blood uric acid levels. There was no correlation between the estimated size of the tumor masses and pretreatment uric acid excretion. The response to treatment could not have been predicted by measurement of the pretreatment uric acid excretion.
In one patient with extensive tumor infiltration of the kidneys, dangerous renal failure, preceded by marked hyperuricemia, developed during therapy. Mechanical hemodialysis resulted in clinical improvement and marked reduction in the blood levels of uric acid and urea.
The finding of a large increase in uric acid excretion during the early days of treatment of a patient with lymphoma is indicative of a responsive tumor. Such data also serve as warning of potential obstructive uric acid nephropathy or uropathy before major increases in serum uric acid appear. Small increases of uric acid excretion in association with treatment could not be correlated with objective clinical response.