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

Abstract

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.

A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia

“…To our knowledge, there have been no previous reports documenting PRES from renal leukemic infiltration and AKI, as occurred in this patient. Similar to our case, an adult hemodialysis patient with previously well‐controlled hypertension developed severe hypertension (210/110), coincident with documented enlargement of kidneys and bone marrow biopsy diagnostic of T‐cell ALL 29 . Blood pressure improved with treatment of this adult patient's leukemia.…”

“…Similar to our case, an adult hemodialysis patient with previously well-controlled hypertension developed severe hypertension (210/110), coincident with documented enlargement of kidneys and bone marrow biopsy diagnostic of T-cell ALL. 29 Blood pressure improved with treatment of this adult patient's leukemia. Of note, while leukemic infiltration of the kidneys tends to occur in late stages of ALL and has been associated with a poor prognosis in some, 30 the patient in our case is doing well over 18 months into his therapy.…”

Hypercalcemia, multiple osteolytic lesions, and acute renal failure: a rare presentation of B-cell acute lymphoblastic leukemia

“…Additionally, other leukemic blasts-producing cytokines including transforming growth factor-α, tumor necrosis factor, interleukin-1, and prostaglandin E2 may affect these phenomena [10]. Although leukemic infiltration of the kidney is usually asymptomatic, it can lead to bilateral renal enlargement, acute kidney injury (AKI), or secondary hypertension [11]. If recurrent hyperuricemia and AKI are persistent, it may be an early presentation of childhood leukemia and need to examination of bone marrow and kidney [12].…”