Acute lymphoblastic leukemia presenting as acute renal failure

Suh, William M.; Wainberg, Zev A.; Vos, Sven de; Cohen, Arthur H.; Kurtz, Ira; Nguyen, Minhtri K.

doi:10.1038/ncpneph0400

Cited by 21 publications

(13 citation statements)

References 17 publications

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“…3 The kidneys are the most frequent extramedullary site of leukemic infiltration, which was identified in 63% of autopsies performed on patients who had died with either lymphoid or myeloid leukemia. 4 Kidney involvement of leukemic cells might be related to the embryological orgin of hematopoietic organ developments.…”

Section: Discussionmentioning

confidence: 99%

“…Kidney biopsy was considered before chemotherapy, but this procedure could not be performed because of uncontrolled hypertension and severe thrombocytopenia. After the first chemotherapy, his neutrophil counts dropped under 500/mm 3 , and febrile neutropenia developed. On the following days, despite the appropriate antibiotherapy, he had severe dyspnea and tachypnea.…”

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confidence: 99%

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Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient

Türkmen

Altıntepe²,

Güney³

et al. 2010

IJNRD

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Leukemic infiltration of the kidney is usually silent, and the admission of the patients with renal dysfunction or acute kidney injury is uncommon. We present a 34-year old hemodialysis patient with new onset of uncontrolled hypertension, erythropoietin-resistant anemia, thrombocytopenia, and Bell's palsy. On admission, his blood pressure (BP) was 210/110 mmHg and he had petechiae and purpura at upper and lower extremities. Renal ultrasonography (USG) showed bilaterally enlarged kidneys without hydronephrosis, unlike his previous USG, which determined bilaterally atrophic kidneys. Acute lymphoblastic leukemia, hypertensive crisis due to bilateral leukemic cell infiltration of kidneys, tumor lysis syndrome, and leukemic involvement of the facial nerve were diagnosed. Despite intense antihypertensive management, his BP was not controlled. After prednisolone, daunorubicine, and vincristine therapy, the size of kidneys diminished and his BP dropped under normal range. In conclusion, pathological findings such as uncontrolled hypertension, flank pain, skin rashes, and abnormal blood count should be considered carefully, even in patients with end-stage renal disease receiving renal replacement therapy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient

Türkmen

Altıntepe²,

Güney³

et al. 2010

IJNRD

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“…Renal function in patients with renal involvement tended to be lower than in those without renal involvement, but no patient developed tumor lysis syndrome or acute renal failure, probably due to the fact that lymphoblasts mainly infiltrate interstitial areas and do not directly damage nephron function. [32][33][34] There have been reports, however, of acute renal failure caused by leukemic infiltration of the kidney in childhood ALL, 4,35,36 and therefore careful observation of patients with renal involvement is necessary.…”

Section: Discussionmentioning

confidence: 99%

Accurate detection of renal leukemic involvement in children using 3‐D computed tomography modeling

Fujiki

Nishimura

Mase

et al. 2019

Pediatrics International

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Background The rate of renal involvement in pediatric acute lymphoblastic leukemia (ALL) at diagnosis varies between reports because renal involvement is diagnosed on renal size larger than aged‐matched standards on conventional modalities. We propose a new method for precise renal involvement detection using 3‐D enhanced computed tomography (CT) reconstruction. Methods Twenty‐five children with ALL were evaluated utilizing 3‐D enhanced CT reconstruction to measure renal volume before and after induction therapy, renal mass lesions and renal axis at diagnosis. Renal involvement was defined as a marked decrease of renal volume or the presence of mass lesions. Results According to the 3D‐CT criteria, nine of 25 patients (36%) had renal involvement. All of them had bilateral mass lesions except for one who had diffuse nephromegaly alone. This method detected renal involvement more accurately than ultrasonography. When using conventional criteria based on the length of the renal axis, 19 of 25 (76%) had renal involvement, including many cases of false‐positive nephromegaly. Patients with renal involvement had significantly more extramedullary involvement according to the 3D‐CT‐based criteria. Conclusions The use of 3D‐CT reconstruction was accurate in detecting renal involvement in childhood ALL, most of which consisted of piled up mass lesions. Patients with renal involvement should be worked up for the detection of other extramedullary lesions.

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“…[34] Renal involvement can present as renal enlargement due to leukemic infiltrates or as renal failure due to uric acid nephropathy. [56] However, other causes such as nephrotoxic drugs, infections, and obstructive uropathy due to para-aortic lymph nodes, retroperitoneal mass, urolithiasis, or ureteral clots can also occur.…”

Section: Discussionmentioning

confidence: 99%