Can Leukemia Cause Kidney Failure

Kidney Involvement In Leukemia And Lymphoma

• Randy L. LucianoAffiliationsYale University School of Medicine, New Haven, CT and Section of Nephrology, Yale University School of Medicine, New Haven, CT
• Ursula C. BrewsterCorrespondenceAddress correspondence to Ursula C. Brewster, MD, Section of Nephrology, Yale University School of Medicine, 330 Cedar Street, Boardman Building 121, New Haven, CT 06520.AffiliationsYale University School of Medicine, New Haven, CT and Section of Nephrology, Yale University School of Medicine, New Haven, CT

Intrarenal Acute Kidney Injury

Intrarenal causes of kidney injury in leukemia can be grouped into ischemic and nonischemic ATN, tubulointerstitial disorders, renovascular disorders, and glomerulopathies. Hemodynamically mediated injury, caused by severe volume depletion, heart failure, or sepsis, and drug-induced injury are common with leukemia. However, it is critical to separate these processes from AKI directly caused by leukemia, as therapy is targeted towards the malignancy as opposed to general supportive measures, and prognosis depends on successful treatment of the underlying disease. Subsequent sections will focus on intrarenal AKI specific to hematologic malignancy.

A. B.

Common Comorbidities In Cll/sll

A large study looked at 8,055 people with chronic lymphocytic leukemia over several years. Among the participants, 35 percent had one comorbidity, and 12 percent had multiple comorbidities. The most common comorbidities included:

• Chronic heart failure or history of heart attack
• Cerebrovascular disease, such as stroke
• Type 1 or type 2 diabetes
• Chronic lung disease
• Peripheral vascular disease

Those with comorbidities were 14 percent more likely to die during the period of the study than those without comorbidities.

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Acute Kidney Injury From Renovascular Disorders

Renovascular-mediated kidney injury includes disorders that lead to the thrombosis of large vessels that perfuse or drain the kidneys or endothelial damage and injury to the microvasculature of the kidney. In these diseases, several factors contribute to thrombosis of the renal vasculature, including leukostasis, malignancy-associated nephrotic syndrome leading to loss of procoagulant molecules, and comorbid conditions or treatments that can lead to activation of the clotting cascade. Both renal artery and renal vein thrombosis have been described in leukemia. Thrombotic microangiopathies have also been reported in both acute and chronic leukemias, resulting in AKI.

Chronic Kidney Disease After Hct

Chronic kidney disease is an important long-term complication of HCT, particularly allogeneic HCT . Given the number of allogeneic transplants performed yearly , the overall burden of CKD in survivors of allogeneic HCT represents a significant future public health problem .

Thrombotic microangiopathy after HCT is probably multifactorial in cause. Current thinking regarding causes is summarized in . The conditioning regimenâparticularly the irradiationâis thought to be the primary cause of renal endothelial damage, with post-HCT factors such as graft versus host disease, infections, and medications playing a later modulatory role . Tubular damage and interstitial fibrosis are seen in animal models of radiation nephropathy, and whether these changes are secondary to the glomerular damage or the direct result of irradiation remains unresolved . Note that the time course for development of renal failure is typical of radiation-induced kidney damage: Kidney cells have much slower turnover than mucosal cells and thus manifest radiation damage much later .

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Renal Infiltration And Obstruction

The renal parenchyma is infiltrated by monomorphic lymphocytes with an immunotype characteristic of CLL/small lymphocytic lymphoma. Immunohistochemistry stains reveal strongly positive B-cell marker CD20, negative T-cell marker CD3 and aberrantly expressed T-cell marker CD5.

Obstructive nephropathy in the setting of CLL can be observed and is diagnosed radiographically via ultrasound, MRI or CT scan. Bilateral hydronephrosis from obstructing nodes is managed with decompression and treating the underlying CLL .

Acute Kidney Injury In Leukemia

AKI in patients with leukemia is common. A study examining 349 patients with all forms of hematologic malignancy admitted to the intensive care unit demonstrated some form of AKI in 149 patients . Of patients with AKI, 29% required renal replacement therapy, with a mortality rate of 72%. In 1411 intensive care unit patients, the diagnosis of a hematologic malignancy, leukemia or lymphoma, had the greatest risk for AKI , relative to other more common conditions seen in critically ill patients, including infection, cirrhosis, and cardiovascular disease. The presence of hematologic malignancy also had the greatest risk of death in all AKI patients. The approach to a patient presenting with AKI in the setting of leukemia involves assessing potential prerenal, intrarenal, and postrenal etiologies .

Prerenal	Nausea, emesis, diarrhea Hemorrhage Increased insensible losses Reduced renal perfusion Medications
Intrarenal	See Table 37.2 for complete list Renovascular disorders

NSAIDs RAAS

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What Is Myeloma Kidney

Kidney failure is a common complication of multiple myeloma. When first diagnosed, as many as 20-40% of patients with multiple myeloma will have some amount of kidney failure. Multiple myeloma can affect the kidney in several ways. It can affect the filter , the tubules , or the tissue of the kidney itself . The effect of multiple myeloma on the glomerulus due to light chain, heavy chain deposition, and amyloidosis will be reviewed on this web site under those specific topics. This page is going to focus on the affect of multiple myeloma on the tubules of the kidney, commonly referred to as myeloma kidney. It is also known as cast nephropathy.

Common Comorbidities In Aml

Studies have shown that among older adults with acute myeloid leukemia, people with a higher comorbidity burden tend to have worse reactions to leukemia treatment and worse overall survival rates. People with AML may also be more likely to have certain chronic conditions. One study compared 3,911 people aged 65 or older with AML with the same number of similarly aged people without AML. Compared with those who did not have AML, those with AML were more likely to also have:

• Cardiovascular disease
• Stroke

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Common Comorbidities In Cml

In one study of 1,519 people with chronic myeloid leukemia, those who had comorbidities at the time of their leukemia diagnosis did not live as long as those who did not have other conditions.

The most common comorbidities seen in people with CML include:

• Type 2 diabetes
• Other types of cancer
• Cardiovascular disease, including heart attack, heart failure, peripheral vascular disease, and cerebrovascular disease

Relapsed Acute Lymphoblastic Leukemia Presenting As Acute Renal Failure

Ashley Rose

1Internal Medicine, University of South Florida, Tampa, FL 33602, USA

2Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33602, USA

Abstract

Acute lymphoblastic leukemia 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 decade of life . 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 . 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 . 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 . Biopsy is essential to the diagnosis of renal infiltration of leukemia. We present a case of acute renal failure secondary to bilateral renal infiltration of ALL presenting as the first sign of relapse in a young man.

1. Introduction

2. Case Presentation

, Computed tomography scan showing symmetric enlargement and hypoattenuation of bilateral kidneys with associated fat stranding involving the renal sinuses and perinephric fat. Left sided urinary stent in in place. No hydronephrosis or nephrolithiasis.

3. Discussion

Conflicts of Interest

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Management Of Arf After Hct

Evaluation of the patient should be as for any patient with hospital-acquired ARF but with particular focus on the contributionâif anyâof hepatorenal syndrome to the clinical picture. Where possible, further exposure to nephrotoxic drugs should be minimized: If calcineurin inhibitor trough concentrations are high, then reduction in dose should be considered alternatives to amphotericin are now available . No randomized controlled trials have compared intermittent hemodialysis with continuous therapies in the setting of severe ARF after HCT. Whatever the modality used, it should be noted that the prognosis in those who develop severe liver and renal failure is very poor. Continuous therapies do offer at least two potential advantages: in the setting of hepatorenal syndrome, there is some evidence that they are associated with less increase in intracranial pressure the daily obligate fluid intake in these patients is frequently massive and is most easily controlled by a continuous method. Vascular access can be problematic because of thrombocytopenia and neutropenia predisposing to bleeding and infection, respectively.

The Spectrum Of Kidney Pathology In B

• Affiliation Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France

• Affiliation Service dAnatomie Pathologique, CHU Hôpitaux de Rouen, Rouen, France

• Affiliation Service dAnatomie Pathologique, CHU Hôpitaux de Rouen, Rouen, France

• Affiliation Service dHématologie, Centre Henri Becquerel, Rouen, France

• Affiliation Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France

• Affiliation Service de Néphrologie, CHU Hôpitaux de Strasbourg, Strasbourg, France

• Affiliations Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France, INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France

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How Is Kidney Damage Treated

Kidney damage is usually reversible, if it is carefully managed to control the life-threatening complications. Once the drug or drugs that are causing the kidney damage are stopped, treatment focuses on preventing the excess accumulation of fluids and wastes while allowing the kidneys to heal. This may be achieved in several ways, including diuretics, sodium polystyrene sulfonate, diet modification, dialysis or drugs.

Diuretics: Your doctor may prescribe a diuretic to increase the amount of water you excrete in the urine. A commonly used diuretic is furosemide .

Sodium polystyrene sulfonate: This medication helps lower the amount of potassium in your blood by binding with the potassium in your stomach or gut so that you excrete it. This medication is administered by mouth or in an enema.

Diet modification: Your doctor may recommend that you restrict substances that are normally excreted by the kidney. This may include foods high in protein, sodium and potassium.

Dialysis: Dialysis is the use of a machine to remove excess waste and fluid. Your blood is routed through the dialysis machine then back into your body. Dialysis is not necessary for every patient, but may be lifesaving, particularly if you have very high levels of potassium in your blood.

Drugs: Amifostine , sodium thiosulfate, and diethyldithiocarbamate may help prevent or reduce the kidney toxicity associated with cisplatin

What Is A Comorbidity

When someone has more than one health condition at the same time, the conditions are known as comorbidities. Comorbid conditions may be related to leukemia in different ways. When an additional medical condition makes an existing disease harder to treat, it is known as a complication. In people with leukemia, having a comorbidity can complicate cancer treatment and add to the disease burden.

Age plays a role in the risk for developing comorbidities. The longer a person lives, the more likely they are to be diagnosed with a chronic condition. Older people are more likely to have multiple chronic conditions. Some types of leukemia are also more likely to occur in older adults.

Here are the average ages at diagnosis of the four main types of leukemia:

• Acute lymphoblastic leukemia 15 years
• Acute myeloid leukemia 67 years
• Chronic lymphocytic leukemia/small lymphocytic lymphoma 71 years
• Chronic myeloid leukemia 64 years

Older people are more likely to have certain types of leukemia as well as other health conditions at the same time.

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Conditions Related To Leukemia

Leukemia is a type of blood cancer. In leukemia, cancer cells crowd out healthy white blood cells, red blood cells, and platelets in the bone marrow. If you have leukemia, having other health conditions at the same time can make leukemia harder to treat and may even influence your cancer prognosis. Understanding how other health conditions are related to leukemia can help you talk to your doctor about treatment and lifestyle changes. Addressing related conditions may improve your quality of life, prolong survival, and lower the risk for life-threatening complications.

What Is Acute Renal Failure

Acute renal failure is a malfunction of the kidneys so that they are unable to perform the vital function of filtering out waste from the blood. Acute renal failure may be caused by decreased blood supply to the kidneys from drugs or infection, damage to the kidneys, or by blockage in the urinary system. The most common cause of acute renal failure in cancer patients is damage to the cells in the kidney.

The kidneys are fist-sized organs located in your lower back, near your spine. Their chief functions are to filter out waste products and regulate electrolytes and water levels. When the body breaks down protein from the diet for energy or building tissues, it produces a waste product called urea. Urea circulates in the blood until it is filtered out by the kidneys and excreted in the urine. When the kidneys are not functioning properly, filtration is reduced and urea builds up in the blood. Also the balance of electrolytes and water cannot be adequately regulated, resulting in a buildup of potassium, sodium and fluid.

Kidney damage may also result in increased excretion of protein in the urine. Protein is an important component in our blood that carries food, hormones, and many other things through the body. Under normal conditions, blood proteins do not pass through the kidneys into the urine because they are too big. If you have kidney damage, protein may pass into your urine. Protein in the urine may be a sign of permanent kidney damage, or failure.

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Overall Survival Among The Most Common Causes Of Renal Pathology

In our study, the four most common renal pathology findings were MPGN, CLL infiltration as primary etiology, MCD and TMA. After a median follow-up of 60 months , deaths were reported in 19 patients including one of ten patients with MPGN, four of six patients with CLL infiltration , two of six patients with TMA, and none of five patients with MCD. The median overall survival was reached only in cases with CLL infiltration and was 84 months . The median overall survival has not been reached in patients with MPGN, MCD and TMA .

How Did I Get It

Multiple myeloma is a type of blood cancer and we do not know exactly why people get it. It is a rare disease and affects only about 1 in 4,000 people. Each year about 13,000-20,000 people will be diagnosed with this disease.

There are some studies that show people who have been exposed to certain toxins like radiation, benzene, herbicides, insecticides, and organic solvents are more at risk than the general population. However, many people develop multiple myeloma without any exposure to these agents. Typically the age at which people are most likely to be diagnosed with multiple myeloma is in their 50s and 60s.

We often do not know why people develop this disease and it is not possible to predict who will develop it. In order to get myeloma kidney, you must have multiple myeloma.

Not all patients with multiple myeloma will develop myeloma kidney, generally about 30-50% of patients develop this problem. There are things that will make a patient with multiple myeloma more at risk to develop myeloma kidney. Dehydration, therapy with furosemide , high blood levels of calcium, and high levels of sodium in the urine all can lead to increased formation of these casts.

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Leukemia And Kidney Failure

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What Are The Chances That I Will Get Better

The prognosis for multiple myeloma depends in large part on if the kidney is affected and how badly. Patients who have kidney dysfunction will have an average survival of 20 months . Those patients without kidney dysfunction will have an average survival of 40 months . Among all patients, response to chemotherapy is very important as well. Patients whose kidney function improves with chemotherapy have an average survival of 3 years. Those patients whose kidney function does not improve with chemotherapy will only live an average of 10 months.

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What Are The Symptoms

The symptoms of multiple myeloma are typically fatigue, bone pain, and infections. This is because multiple myeloma causes anemia, destruction of the bones, and decreased production of normal antibodies that fight infection. The destruction of the bones due to multiple myeloma can often lead to fractures of the bone that occur with little or sometimes no trauma. Often, though, the signs of kidney dysfunction will be first discovered on lab work done for another medical reason.

Lab results could show increased level of creatinine, or increased amount of protein in the urine. People who develop advanced kidney disease will have symptoms related to kidney failure including nausea, itching, confusion, and fatigue.

Prognosis Of Kidney Disease In Cats

There is no cure for kidney disease in cats, but with good care and appropriate treatment, a cat with kidney disease may live for months or even years.

The prognosis for kidney disease varies dramatically depending on when it is diagnosed, Dr. Taylor says. Early detection and diet change at the appropriate time can extend good quality of life by years.

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