Paraneoplastic hypokalemia in acute myeloid leukemia: a case of renin activity in AML blast cells

Abstract

Hypokalemia due to renal potassium loss has frequently been observed in patients with acute myeloid leukemia (AML). The pathogenic mechanism for this hyperkaluresis is unclear. In this report we describe a patient with AML FAB M4, in whom the clinical course, the electrolyte disturbances, the serum aldosterone levels, and the diffuse hyperplasia of the adrenal cortex documented a typical case of marked secondary hyperaldosteronism. On analysis of the leukemic cells of this patient compared with normal bone marrow cells, a significant increase of renin-like activity in the cytosol of the blast cells was noted. Activation of the renin-angiotensin-aldosterone system by paraneoplastic production of renin-like activity in AML blast cells might contribute to the hypokalemia often observed in patients with acute myeloid leukemia.

Is increased renin activity as a paraneoplastic phenomenon in acute leukemia a protective mechanism against hyperkalemia?

“…Dear Sir, I have read with great interest the case report by Wulf et al about paraneoplastic hypokalemia in acute myeloid leukemia [11]. Hypokalemia is a well-recognized and frequent (25-59%) electrolyte disturbance occurring during the course of acute leukemia (AL) [3].…”

“…During the course of the disease, antibiotic-induced hyperkaliuria and the mineralocorticoid effects of steroids used in therapy may contribute to hypokalemia [3,6]. Wulf et al in their report state that aldosterone secretion in their patient was due to reninlike enzyme activity produced by the neoplastic leukemic cells [11]. It is hard to generalize this concept to all patients with leukemia.…”

A Case of Myelolipoma with Bilateral Adrenal Hyperaldosteronism Cured after Unilateral Adrenalectomy

“…It is possible that the adipose tissue element of the myelolipoma was secreting mineralocorticoid-releasing factors. The hematopoietic element may release renin-like enzyme activities, because leukemia cells released renin-like enzyme activities and resulted in hyperaldosteronism with diffuse hyperplasia of the zona glomerulosa of the adrenal cortex in a patient with acute myeloid leukemia (23). In the present case, it is unlikely that the tumor was releasing renin-like enzyme activities, because PRA, as all enzyme activities generating angiotensin I, was low.…”

Renin-Angiotensin System (RAS) Expressions in Myeloid Leukemic Cell Lines.

“…Renin-like enzyme activity converting ANGTS to Ang-I had been detected in leukemic blast cells. 24,25 Specific immunoreactive renin-like peptide of 47 kDa was isolated from AML blast cells. 24,25 Renin is expressed in some myeloid human leukemia cell lines such as K562, KU812 and MEG-01.…”

“…24,25 Specific immunoreactive renin-like peptide of 47 kDa was isolated from AML blast cells. 24,25 Renin is expressed in some myeloid human leukemia cell lines such as K562, KU812 and MEG-01. 9,18,26 Renin system is present in the K562 leukemic cell line in vitro model.…”