Sonographic findings in leukemic renal disease

Imaging features of haematological malignancies of kidneys

Haematological malignancies are relatively uncommon neoplasms of kidneys. Nevertheless, the incidence of these neoplasms is increasing, partly due to more widespread use of computed tomography and magnetic resonance imaging. This article discusses the clinical and imaging features of renal lymphoma, leukaemia, extra-osseous multiple myeloma, and post-transplant lymphoproliferative disorder. Although there is overlap of imaging features with other more common malignancies, such as transitional and renal cell cancers, the combination of imaging findings and the appropriate clinical picture should allow the radiologist to raise a provisional diagnosis of a haematological neoplasm. This has management implications including the preference for image-guided core biopsies and a shift towards medical rather than surgical therapy.

The role of ultrasound in renal insufficiency: the essentials

Sonography is the best screening modality to evaluate patients presenting with renal insufficiency. Ultrasound findings can be normal in patients with renal disease, especially in prerenal azotemia and acute parenchymal renal disease. Echogenic kidneys indicate the presence of parenchymal renal disease; the kidneys may be of a normal size or enlarged. Small kidneys suggest advanced stage chronic kidney disease. Uncommonly, cystic disease of the kidney, especially adult type polycystic kidney disease may be the cause of the patient's renal insufficiency with bilaterally enlarged kidneys containing multiple cysts of various sizes. If hydronephrosis is present, the level and cause of the obstruction should be sought. When ultrasound cannot diagnose the level and cause of obstruction, other imaging modalities, including CT and MRI may be useful. When renovascular disease (arterial stenosis or venous thrombosis) is suspected, spectral and color Doppler can be useful in detecting abnormalities.

Electrolyte abnormalities at diagnosis of acute lymphocytic leukemia may be a clue for renal damage in long-term period

The objective of this study was to determine the frequency of electrolyte perturbations and their relationship with leukemic status before and after chemotherapy in patients with acute lymphocytic leukemia. Blood biochemistry, liver and renal function tests, and renal sonograms were examined at diagnosis and during induction therapy in 334 patients. Renal and electrolyte disturbances were then studied in 116 patients between 3 and 110 months after cessation of the St. Jude chemotherapy treatment protocol. Glomerular filtration rate, electrolyte, protein, and beta-2-microglobulin levels were determined in fresh urine samples, and serum electrolyte levels were examined in blood samples. Renal sonographic examinations and scintigraphic examinations were performed with DMSA and MAG-3. Renal leukemic involvement was detected by sonographic examination in 32 patients who had also presented with hyperphosphatemia or hyperuricemia. Patients with electrolyte disorders at diagnosis were less likely to have tumor lysis syndrome during induction chemotherapy. This may be explained by correction of their electrolyte disorders at the time of diagnosis, which may protect them from tumor lysis syndrome. Hypocalcemia and hyponatremia at the time of diagnosis were found to be significant initial risk factors for renal scan abnormalities and microproteinuria, respectively, during the late therapy period (P < 0.05). Electrolyte abnormalities and renal changes were commonly observed before and after therapy for leukemia. Patients presenting with hypocalcemia and hyponatremia should be examined for microproteinuria and should undergo renal scanning during the late therapy period.

Abdominal ultrasound findings during and after treatment of childhood acute lymphoblastic leukemia

BACKGROUND

The treatment of acute leukemia in childhood has been increasingly successful. Concurrently, severe leukemia-related gastrointestinal complications have become more common.

METHODS

We evaluated the findings of the abdominal ultrasound (US) examinations of 52 children with acute lymphoblastic leukemia (ALL) who had severe clinical symptoms indicating infection or abdominal complication during chemotherapy treatment or after the cessation of such treatment and assessed the impact of these findings on patients' subsequent treatment and survival.

RESULTS

Our study presents ten cases of typhlitis with a prevalence of 9%, all of which were rapidly diagnosed by US and had a favourable outcome. We also found focal intra-abdominal parenchymal lesions in six children, five of them due to fungal infection and one due to leukemic infiltration. Several other intra-abdominal pathologies significant for the patients' treatment are also reported.

DISCUSSION

We believe that abdominal US is a useful, rapid, safe, and accurate imaging method for children with ALL suspected to suffer from leukemia- or chemotherapy-related gastrointestinal complications. More invasive imaging methods are seldom needed.

CONCLUSIONS

According to our results, abdominal US gives the necessary information in most of the cases and provides prompt diagnosis, which may prevent possible fatal complications.