Renal dysfunction due to leukemic infiltration of kidneys in a case of chronic lymphocytic leukemia (original) (raw)

Renal Failure in a Patient with Ibrutinib Refractory Chronic Lymphocytic Leukemia

2019

The incidence of a renal lymphocytic infiltration in Chronic Lymphocytic Leukemia (CLL) is a fairly common phenomenon, found in a variable percentage of cases, as a result of autopsy studies. However, it is uncommon the association of the infiltrate with specific renal histopathological alterations, such as a Granulomatous Interstitial Nephritis (GIN), with severe kidney function impairment. We describe a patient with progressive TP53 mutated CLL who developed acute renal failure due to leukemic infiltration associated with GIN during treatment with ibrutinib, the new inhibitor of the Bruton’s tyrosine kinase. After stopping ibrutinib, the patient obtained a complete remission with high doses of prednisone plus chemoimmunotherapy, but recently he underwent relapse treated now with venetoclax plus prednisone. Paola Casciani1, Massimiliano Postorino1, Francesca Rossi2, Sergio Tripodi3, Annalisa Biagi1, Lisa Mercante1, Roberta Laureana1, Enrico Santinelli1, Maria Ilaria Del Principe1, ...

Acute lymphoblastic leukaemia presenting with acute renal failure: report of two cases

Journal of Pakistan Medical Association, 2008

Acute renal failure is a well-recognized complication of acute leukaemias. However, serious renal failure caused by leukaemic infiltration as a primary manifestation is unusual. Here we report two patients with acute lymphoblastic leukaemia presenting with acute renal failure due to leukaemic infiltration. The first patient died before the administration of specific therapy for leukaemia, whereas the second case recovered after chemotherapy. She was discharged without necessitating dialysis therapy.

Tumor Lysis Syndrome in Chronic Lymphocytic Leukemia: A Rare Case Report from Nephrology

American Journal of Case Reports, 2019

Unusual clinical course Background: Tumor lysis syndrome is common in hematological malignancy, but less frequent in chronic and solid tumors. Almost always it is observed after chemotherapy or radiotherapy initiation, but rarely occurs spontaneously. Case Report: A 89-year-old female with stable chronic lymphocytic leukemia was admitted to the hospital because of worsening dyspnea and dry cough. Her vital signs were normal, except for sinus tachycardia. On physical examination, she appeared distressed, dyspneic, sweaty but afebrile, anxious, but alert and well oriented. Lung examination revealed reduced air entry with bibasilar crackles. No peripheral edema was seen, pulses were normal, and no signs of deep vein thrombosis were observed. Laboratory analysis revealed leukocytosis; but normal hematological and biochemical parameters. Intravenous (IV) furosemide and antibiotics (IV ceftriaxone and orally azithromycin) were started along with steroid therapy (methylprednisolone 62.5 mg, IV). The treatment with steroids lasted for 1 day only, and in the following day, the patient was switched to prednisone (20 mg/day orally) for only 1 additional day. White blood cell count increased on day 1, 2 and 3 after admission, along development of hyperuricemia, hyperphosphatemia, hyperkalemia, acute renal failure and elevated troponin levels. Hemodiafiltration/hemodialysis was initiated, and the patient was discharged after serum concentrations of these electrolytes and kidney function were restored. One month after discharge, the patient denied any malaise and was at stable condition. Conclusions: Herein, we present a case of a patient with stable chronic lymphocytic leukemia, who developed spontaneous tumor lysis syndrome after short low dose of steroid therapy. This case highlights the importance of including spontaneous tumor lysis syndrome in the differential diagnosis of any acute renal failure in the constellation of any malignancy.

Relapsed Acute Lymphoblastic Leukemia Presenting as Acute Renal Failure

Case Reports in Nephrology, 2019

Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults. It is an aggressive hematologic neoplasm, with a bimodal age distribution typically presenting in childhood and the 6th decade of life (Terwilliger and Abdul-Hay, 2017). Renal injury in ALL is common and can occur through many different mechanisms, such as prerenal acute kidney injury, acute tubular necrosis, renovascular disease, obstruction, glomerulonephritis, and parenchymal infiltration of tumor cells (Luciano and Brewster, 2014). Infiltration of kidneys by leukemia cells is common; however a resultant injury only occurs in about 1% of patients, and renal failure is even more rare (Luciano and Brewster, 2014). Renal failure due to bilateral infiltration of tumor cells has been reported in only a few cases and is thought to be a poor prognostic indicator (Luciano and Brewster, 2014; Sherief et al., 2015). Biopsy is essential to the diagnosis of renal infiltration of leukemia. We present a case...

Acute renal failure due to lymphomatous infiltration of the kidneys

Journal of the American Society of Nephrology, 1997

Acute renal failure (ARF) is an unusual manifestation of lymphomatous infiltration of the kidneys. In this article, a patient whose initial presentation of lymphoma was the sudden onset of painless hematuria and ARF is described. The absence of other causes of ARF, together with massively enlarged unobstructed kidneys on renal ultrasonography, strongly suggested an infiltrative process. Renal biopsy established the diagnosis of non-Hodgkin's lymphoma. Pulse steroid therapy was associated with rapid improvement of renal function and kidney size, but a moderate degree of tumor lysis syndrome ensued. Further recovery followed with chemotherapy. Whereas widespread infiltration of the kidneys is present in almost one third of patients with lymphoma at autopsy, this rarely causes clinical symptoms. Nevertheless, because it often responds to therapy, lymphomatous infiltration should be suspected in any patient presenting with unexplained ARF and enlarged kidneys, especially in the sett...

Leukemic Infiltration of Kidney in a Case of T-cell Acute Lyphomatous Leukemia

Journal of Postgraduate Medicine, Education and Research

Kidney involvement in acute lymphomatous leukemia (ALL) presenting as acute kidney injury (AKI) is uncommon. We document a case report of a 19-year-old male who presented with loss of weight, weakness, and anorexia. On evaluation, he was found to have T-cell ALL with AKI. Renal biopsy was done, and immunohistochemistry (IHC) confirmed renal infiltration by the leukemic T cells. The patient was started on chemotherapy, and improvement of renal function with subsequent bone marrow showed an initial complete remission. This case illustrates the uncommon presentation of T-cell ALL as AKI.