Nephrotic syndrome in acute promyelocytic leukemia

Glomerulonephritis Secondary to Acute Promyelocytic Leukemia that Resolved after Induction Therapy

“…Apart from the aforementioned six case reports of APL and nephrotic proteinuria [3,5,[9][10][11], including ours, a comprehensive review of the literature (including terms glomerulonephritis, nephrotic range proteinuria, and NS) allowed us to verify that only six additional cases of non-APL AML subtypes have been reported so far [1,2,4,[6][7][8]. For some reason that we cannot explain, the proportion of cases with APL in all reported AML patients (50%) does not correspond to the incidence of this subtype among AML (7-15%).…”

“…Although our case was not documented with renal biopsy, nine of the cases reported in the literature described histopathological findings in renal biopsy or in postmortem studies. The excellent review by Moradveisi et al [11] showed that these had a heterogeneous pattern, which varied from minimal changes to focal segmental glomerulosclerosis, immune complex deposition, macrophage infiltration, membranous glomerulonephritis (MGN), proliferative glomerulonephritis (PGN), and detachment of epithelial cells from the glomerular basement membrane (GBM). In fact, the only 3 patients with APL for whom histopathological studies were available had different lesions each: PGN, epithelial-GBM detachment, and focal segmental glomerulosclerosis.…”

“…The association of proteinuria and malignant hematological disease, although infrequent, is well known, with chronic leukemias, lymphomas, and monoclonal gammopathies the most frequent diseases involved. However, only a few cases of acute myeloid leukemia (AML) have been reported associated with glomerulonephritis so far [1][2][3][4][5][6][7][8][9][10][11]. Interestingly, almost half of the reported cases were acute promyelocytic leukemia (APL), which does not correspond to the proportion of this subtype among AML.…”

Disparate roles of retinoid acid signaling molecules in kidney disease

“…AKI occurred in 71.4% of patients with RA syndrome (20). Renal injuries associated with ATRA treatment include tubular necrosis (21), granulomatous interstitial nephritis (22), renal infiltration by lymphocytes, cortical necrosis (20), and drug-induced nephrotic syndrome (23). The potential mechanism of ATRA-mediated side effect includes: 1) release of a variety of cytokines by differentiating blast cells such as IL-1b, IL-6, IL-8, and TNF-a; 2) a change in adhesive properties of blasts cells such as lymphocyte function-associated antigen 1, intercellular adhesion molecule-1, intercellular adhesion molecule-2, very late antigen 4, and vascular cell adhesion molecule 1; and 3) a hypercoagulable state due to upregulation of thrombomodulin and rapid correction of low fibrinogen levels in APL (24).…”