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Kala J, Finkel KW. Onconephrology. Crit Care Clin 2021; 37:365-384. [PMID: 33752861 DOI: 10.1016/j.ccc.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current advances in cancer chemotherapeutics have remarkably helped in rapid and definitive treatment options. However, these potent chemotherapeutics have been associated with severe renal toxicities that later impact treatment options. Acute kidney injury is common in patients with cancer. In hospitalized patients with cancer, acute kidney injury is associated with increased morbidity, mortality, length of stay, and costs. This article provides an overview of acute kidney injury caused by cancer or its treatment, including prerenal, tubular, glomerular diseases, infiltrative disease, tumor lysis syndrome, anticancer drug nephrotoxicity, hematopoietic stem cell transplantation-related acute kidney injury, and cancer-associated thrombotic microangiopathy.
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Affiliation(s)
- Jaya Kala
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, 6431 Fannin Street, MSB 5.134, Houston, TX 77030, USA.
| | - Kevin W Finkel
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, 6431 Fannin Street, MSB 5.134, Houston, TX 77030, USA
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Puigrenier S, Gnemmi V, Gibier JB, Dubois R, Collet G, Tricot S, Quémeneur T, Ulrich M. [Intravascular large B cell lymphoma pathological findings led by positron emission tomography findings: About one case]. Nephrol Ther 2020; 16:372-375. [PMID: 32753278 DOI: 10.1016/j.nephro.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/07/2020] [Accepted: 03/29/2020] [Indexed: 10/23/2022]
Abstract
Intravascular large B cell lymphoma is a rare non-Hodgkin large B cell lymphoma disease, with heterogeneous clinical manifestation and difficult pathological diagnosis. Positron emission tomography may be helpfull in this context and has already been reported. A 45-year-old woman was admitted for persistent high fever, inflammatory syndrome and unexplained haemophagocytic syndrome. Bilateral cortical renal hypermetabolism at positron emission tomography initially misled to pyelonephritis diagnosis and secondarily led to kidney biopsy, which showed intravascular large B cell lymphoma. Renal involvement in intravascular large B cell lymphoma is rare and is usually characterized by acute renal failure and proteinuria. Global hypermetabolism at positron emission tomography has already been described in this context, but cortical hypermetabolism has never been associated with pathological findings. In front of persistent high fever without etiology, this positron emission tomography feature must lead to intravascular large B cell lymphoma suspicion and to kidney biopsy to obtain pathological proof.
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Affiliation(s)
- Sébastien Puigrenier
- Service de néphrologie et médecine interne, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Viviane Gnemmi
- Service d'anatomie et cytopathologie, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Jean-Baptiste Gibier
- Service d'anatomie et cytopathologie, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Romain Dubois
- Service d'anatomie et cytopathologie, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Guillaume Collet
- Service de médecine nucléaire, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Sabine Tricot
- Service d'hématologie, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Thomas Quémeneur
- Service de néphrologie et médecine interne, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - Marc Ulrich
- Service de néphrologie et médecine interne, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France.
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Chhakchhuak M, Bajpai N, Purohit A. CRAB Positive Acute Lymphoblastic Leukemia, Masquerader of Multiple Myeloma. Indian J Hematol Blood Transfus 2019; 36:417-418. [PMID: 32425404 DOI: 10.1007/s12288-019-01209-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Malsawmkima Chhakchhuak
- 1Department of Nephrology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Nitin Bajpai
- 1Department of Nephrology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Abhishek Purohit
- 2Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
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Fujiki T, Nishimura R, Mase S, Kuroda R, Ikawa Y, Araki R, Maeba H, Yachie A. Accurate detection of renal leukemic involvement in children using 3-D computed tomography modeling. Pediatr Int 2019; 61:679-687. [PMID: 31173414 DOI: 10.1111/ped.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/29/2019] [Accepted: 06/03/2019] [Indexed: 12/01/2022]
Abstract
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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Affiliation(s)
- Toshihiro Fujiki
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ryosei Nishimura
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shintaro Mase
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Rie Kuroda
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yasuhiro Ikawa
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Raita Araki
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hideaki Maeba
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiro Yachie
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
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Pre-B acute lymphoblastic leukemia with t(1;19) in an adult initially presenting as hematuria and bilateral renal enlargement: a case report and literature review. Clin Nephrol Case Stud 2017; 5:60-65. [PMID: 29043149 PMCID: PMC5642469 DOI: 10.5414/cncs109113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/02/2017] [Indexed: 11/18/2022] Open
Abstract
Although pre-B acute lymphoblastic leukemia (ALL) is the most common type of renal leukemic infiltration; the renal infiltration with leukemia cells as the initial manifestation of leukemia is very rare. Translocation (1;19)(q23;p13) is one of the most common chromosomal abnormalities in patients with ALL and is observed in 5 - 6% of children with pre-B ALL. However, the incidence of t(1;19) in adults is lower, not exceeding 3%, and the prognosis of adult patients is usually poor. Herein, we report a 52-year-old female patient with pre-B ALL who initially presented as bilateral renal enlargement. The cytogenetic analysis revealed chromosomal abnormalities including t(1;19). The patient underwent three consecutive courses of chemotherapy with VDLP (vincristine, daunorubicin, L-asp, and prednisolone) and gained a short complete remission. Her kidneys recovered to normal size, and renal function returned to normal level. However, after complete remission for only 3 months, the patient exhibited resistance to consolidation chemotherapy and indicated evidence of marrow relapse. Although we increased the drug dosage and attempted to use a different protocol, she died of severe anemia and hemorrhage almost 10 months after she was first admitted. In conclusion, pre-B cell ALL is the most common type of leukemia to present with renal infiltration as the presenting sign. Because of the poor outcome of ALL, some new therapeutic approaches may improve the patients' conditions.
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Cunningham I, Kohno B. 18 FDG-PET/CT: 21st century approach to leukemic tumors in 124 cases. Am J Hematol 2016; 91:379-84. [PMID: 26718745 DOI: 10.1002/ajh.24287] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/22/2015] [Indexed: 12/11/2022]
Abstract
Extramedullary tumors remain an obstacle to curing more acute leukemia patients. Their incidence is unknown because the presence of occult tumors that contribute to relapse is not routinely sought as in other cancers. No standard approach exists for treating tumors at most sites, apparent clinical response is typically followed by further tumors, and achievement of lengthy remission is uncommon. Body scanning with (18) FDG PET/CT now provides a means to identify the extent of occult tumors that enables directed tumor eradication and a way to evaluate tumor response. To evaluate its potential benefits, analysis was undertaken of 124 published cases scanned after apparent tumors were diagnosed. Clinical and radiologic exams underestimated extent of disease in over half of 100 cases. Among 70 cases that reported scans after various treatments, 70% achieved negative scans. Half relapsed subsequently but disease-free survivals up to 6 years were documented. These reported cases add to our knowledge of extramedullary leukemia in showing that further tumors are more likely than marrow relapse, clinical and radiologic evaluation of response is inadequate, intensive chemotherapy alone generally does not prevent progression and is associated with significant mortality, and tumor-directed plus systemic therapies appears the most effective approach, particularly to AML tumors. This analysis suggests this technology could increase our ability to eradicate all foci of leukemia, and identify tumors responsible for refractory, residual, and relapsed disease.
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Affiliation(s)
- Isabel Cunningham
- Hematology Oncology; Columbia University College of Physicians and Surgeons; New York
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Sherief LM, Azab SF, Zakaria MM, Kamal M, Elbasset Aly MA, Ali A, Alhady MA. Renal Presentation in Pediatric Acute Leukemia: Report of 2 Cases. Medicine (Baltimore) 2015; 94:e1461. [PMID: 26376384 PMCID: PMC4635798 DOI: 10.1097/md.0000000000001461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Renal enlargement at time of diagnosis of acute leukemia is very unusual. We here in report 2 pediatric cases of acute leukemia who had their renal affection as the first presenting symptom with no evidences of blast cells in blood smear and none of classical presentation of acute leukemia. The first case is a 4-year-old girl who presented with pallor and abdominal enlargement. Magnetic resonance imaging showed bilateral symmetrical homogenous enlarged kidneys suggestive of infiltration. Complete blood picture (CBC) revealed white blood count 11 × 10⁹/L, hemoglobin 8.7 g/dL and platelet count 197 × 10⁹/L. Bone marrow aspiration was performed, and diagnosed precursor B-cell ALL was made. The child had an excellent response to modified CCG 1991 standard risk protocol of chemotherapy with sustained remission, but unfortunately relapsed 11 month after the end of therapy. The second child was 13-month old, presented with pallor, vomiting, abdominal enlargement, and oliguria 2 days before admission. Initial CBC showed bicytopenia, elevated blood urea, creatinine, and serum uric acid, while abdominal ultrasonography revealed bilateral renal enlargement. Bone marrow examination was done and showed 92% blast of biphenotypic nature. So, biphynotypic leukemia with bilateral renal enlargement and acute renal failure was subsequently diagnosed. The patients admitted to ICU and received supportive care and prednisolone. Renal function normalized and chemotherapy was started. The child achieved complete remission with marked reduction of kidney size but, unfortunately she died from sepsis in consolidation phase of therapy. This case demonstrates an unusual early renal enlargement in childhood acute leukemia. Renal involvement of acute leukemia should be considered in child presenting with unexplained bilateral renal enlargement with or without renal function abnormalities and bone marrow examination should be included in the workup.
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Affiliation(s)
- Laila M Sherief
- From the Department of Pediatrics, Faculty of Medicine, Zagazig and Cairo Universities, Zagazig, Egypt
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Miller AR, Cipkala DA, Cain MP. Gross hematuria and focal renal masses as initial features of a mature B-cell leukemia in an adolescent male. Urology 2015; 85:470-3. [PMID: 25559723 DOI: 10.1016/j.urology.2014.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/13/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
We report a case of a 14-year-old boy who presented with gross hematuria and focal bilateral renal masses as presenting features of a mature high-grade B-cell leukemia, Burkitt subtype. The patient was treated with standard chemotherapy with the addition of rituximab and has no evidence of disease on completion. To our knowledge, this is the first case to describe gross hematuria in conjunction with focal bilateral renal masses as presenting features in a pediatric patient with Burkitt leukemia. This unique presentation suggests that early leukemic infiltration of the urinary collecting system may occur but is extremely unusual.
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Affiliation(s)
- Adam R Miller
- Division of Pediatric Urology, Riley Hospital for Children, Indianapolis, IN.
| | - Douglas A Cipkala
- Center for Cancer and Blood Diseases, Peyton Manning Children's Hospital, Indianapolis, IN
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children, Indianapolis, IN
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Tanaka Y, Yakushijin K, Takafuta T. Enlargement of bilateral kidneys by infiltration of leukemic cells in acute lymphoblastic leukemia at relapse after allogeneic hematopoietic stem cell transplantation. Int J Hematol 2013; 98:513-4. [PMID: 24065514 DOI: 10.1007/s12185-013-1447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Yasuhiro Tanaka
- Department of Hematology and Clinical Immunology, Nishi-Kobe Medical Center, 5-7-1, Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan,
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Firwana BM, Hasan R, Hasan N, Alahdab F, Alnahhas I, Hasan S, Varon J. Tumor lysis syndrome: a systematic review of case series and case reports. Postgrad Med 2012; 124:92-101. [PMID: 22437219 DOI: 10.3810/pgm.2012.03.2540] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tumor lysis syndrome (TLS) is a clinical condition that is caused by a massive lysis of tumor cells that accumulate very rapidly and disturb hemodynamics. This oncologic emergency requires immediate intervention. Tumor lysis syndrome was first described in the 19th century. Since then, it has become a well-known disease with improved management measures. Tumor lysis syndrome can occur after any type of neoplasm. It is highly associated with rapidly proliferating tumors compared with those that are well demarcated, such as acute lymphoblastic leukemia and high-grade non-Hodgkin lymphoma. Initiation of chemotherapy, radiotherapy, or steroid treatment may trigger TLS, or it may develop spontaneously. The release of massive quantities of intracellular contents may produce hyperkalemia, hyperphosphatemia, secondary hypocalcemia, hyperuricemia, and acute renal failure. Prevention and treatment measures include intravenous hydration, use of allopurinol and rasburicase, management of TLS-associated electrolyte abnormalities, and renal replacement therapy; the use of urine alkalinization remains controversial. In this article, we summarize the findings of case series and case reports published over the past 6 years in an effort to help familiarize clinicians better recognize and manage TLS.
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Affiliation(s)
- Belal M Firwana
- Department of Internal Medicine, University of Missouri, Columbia, USA
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Seo-Mayer P, Kenney B, McNamara J, Stein J, Moeckel GW. Hematuria and decreased kidney function as initial signs of acute B-cell lymphoblastic leukemia. Am J Kidney Dis 2010; 56:1001-5. [PMID: 20599308 DOI: 10.1053/j.ajkd.2010.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 03/25/2010] [Indexed: 12/17/2022]
Abstract
We report the case of a 14-year-old boy who presented with hematuria and decreased kidney function as initial manifestations of acute lymphoblastic leukemia (ALL). Computed tomography of the abdomen showed extensive retroperitoneal lymphadenopathy and bilateral nephromegaly. The patient's kidney biopsy specimen showed a dense monomorphous interstitial infiltrate of small round blue cells with significant nuclear atypia. Immunohistochemical workup showed positive staining for CD20, CD10, and terminal deoxynucleotidyl transferase (TdT), consistent with ALL. The patient underwent induction chemotherapy, attained remission 4 weeks after induction, and presently is stable in the consolidation phase of chemotherapy. This is an unusual case of ALL involving both kidneys with initial presenting signs of hematuria and decreased kidney function.
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Affiliation(s)
- Patricia Seo-Mayer
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520-8023, USA
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Acute lymphoblastic leukemia presenting as non-oliguric renal failure and hypertension. Leuk Res 2010; 34:e150-1. [PMID: 20089303 DOI: 10.1016/j.leukres.2009.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 11/23/2022]
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