Acute renal failure following hyperthermic isolation perfusion of the left leg.

This is the case report of a 37-year-old female who underwent primary excision of a malignant melanoma on the left foot as well as an inguinal lymphnode dissection in May 1983. In January 1984 a satellitosis on the same foot was treated with an isolation perfusion which had to be repeated in December of the same year due to secondary satellitosis. For the first perfusion, Alkeran 80 mg was used with a temperature of up to 41.4 degrees C, whereas Cis-Platinum 20 mg/l and Eldesine 0.3 mg/l were used for the second perfusion, with a maximum temperature in the tumor area of 39.0 degrees C. On the first postoperative day, significant edema of the left leg accompanied by severe pain was noticed. This was followed by an increase of the serum creatinine to 2.2 mg % two days later. Despite the immediate inducement of a forced diuresis, renal function deteriorated during the following days with serum creatinine going up to 4.8 % and CK to 14800 U/L. After a forced diuresis of two weeks' duration, the laboratory parameters slowly went back to normal. As a consequence of this complication we analyzed the influence of hyperthermic isolation perfusion on five patients with regard to muscular damage and its influence on renal failure. During perfusion we observed myoglobinemia which subsided within 36 hours. This slope was paralleled by CK values. A discrete myoglobinuria which was observed in two patients disappeared within 36 hours after perfusion. No rise of creatinine could be found. The changes described above were not influenced by cytostatic medication (Alkeran versus Cis-Platinum and Eldesine). In addition, none of the cases showed a leakage of over 16%. The case of acute renal failure was apparently caused by increased rhabdomyolysis as a consequence of the second hyperthermic perfusion.