Renal Involvement at Diagnosis of Pediatric Acute Lymphoblastic Leukemia

Abstract

Acute leukemia is the most common type of cancer in pediatric patients. This type of cancer accounts for a third of all childhood cancer cases. More than half of pediatric acute leukemia patients show signs and symptoms such as hepatomegaly, splenomegaly, pallor, fever and bruising at the time of diagnosis. In early stages of acute lymphoblastic leukemia (ALL), nephromegaly and other renal manifestations such as high blood pressure (HBP) and renal failure are uncommon, although renal infiltration and nephromegaly are common in advanced-stage pediatric patients. This is a retrospective case review with a critical appraisal of the existing evidence from the literature. We present a clinical case of a child with HBP associated with bilateral nephromegaly which resolved after chemotherapy treatment. This patient presented with HBP that required pharmacological treatment, likely owing to nephromegaly. All HBP secondary causes were rejected. Nephromegaly was resolved after chemotherapy treatment, and antihypertensive medication was discontinued. Nephromegaly and HBP are rare manifestations of ALL debut in pediatrics. The present case report illustrates this unusual combination and Suggests clinicians to consider malignancy as its causal factor, especially if the symptoms are accompanied by other suggestive extrarenal manifestations.

Bilateral nephromegaly due to direct leukemic cell invasion in the initial and relapse phases of T-cell acute lymphoblastic leukaemia

“…Renal infiltration of ALL is usually observed in the late stages of the disease [5] . Only a few pediatric cases have been reported to show bilateral renal infiltration, causing nephromegaly at diagnosis [6,7] . To the best of our knowledge, there are only three reported adult cases of bilateral nephromegaly due to leukemia infiltration at diagnosis [2,3,8] .…”

“…[ 5 ] Only a few pediatric cases have been reported to show bilateral renal infiltration, causing nephromegaly at diagnosis. [ 6 , 7 ] To the best of our knowledge, there are only three reported adult cases of bilateral nephromegaly due to leukemia infiltration at diagnosis. [ 2 , 3 , 8 ] Additionally, two adult ALL cases showed bilateral nephromegaly at the time of relapse after stem cell transplantation.…”

Biochemical and Hematologic Profiles in B-Cell Acute Lymphoblastic Leukemia Children

“…The common physical features of leukemia patients may include Swollen lymph nodes, splenomegaly and hepatomegaly. Acute cute kidney injury is quite prevalent in leukemic patients, with prerenal and acute tubular necrosis being the most common etiologies 5 . Creatinine and blood urea are two most important parameters to deduce the function of kidney in leukemic patient 6,7 .…”

“…Acute cute kidney injury is quite prevalent in leukemic patients, with prerenal and acute tubular necrosis being the most common etiologies. 5 Creatinine and blood urea are two most important parameters to deduce the function of kidney in leukemic patient. 6,7 Kidneys are also responsible to maintain a balance of electrolytes but due to kidney infiltration by leukemic cells electrolytes imbalance may also be observed in acute leukemia patients.…”

Renal ultrasonographic abnormalities at initial presentation of children diagnosed with acute lymphoblastic leukemia and long-term renal functions and prognosis in survivors

“…In some reports, bilateral nephromegaly (NM) resolving after successful chemotherapy has been considered as a sign of renal leukemic involvement. [ 15 ] However, those radiological findings might also be observed due to tumor lysis syndrome (TLS), infection, and renal failure. [ 16 ] Whatever the cause, the impact of renal ultrasound abnormalities on leukemia prognosis as well as on renal functions still remains undetermined.…”