Clinicopathological Manifestations of Kidney Injury in Leukemia

BackgroundKidney is a major extramedullary organ involved in leukemia, but clinicians have insufficient understanding of it due to rare case reports.ObjectiveTo analyze the clinicopathological manifestations of kidney injury in leukemia.MethodsFive patients with kidney injury in leukemia were recruited from Peking University People's Hospital from June 2010 to June 2020. Their demographics, clinical manifestations, ultrasonic and laboratory examination results, pathological examination results of renal biopsy species, therapeutic regimen and follow-up were retrospectively analyzed.ResultsAll these patients were male, with an onset age ranging from 19 to 73 years old. Two of them had B-cell acute lymphoblastic leukemia after allogeneic stem cell transplantation, the remaining three had B-cell chronic lymphocytic leukemia. All of them had acute kidney injury with proteinuria, and pathologically manifestation of acute interstitial nephritis. In addition, two of them also had leukemia-related glomerular disease. Renal pathology indicated extramedullary recurrence in the two cases of B-cell acute lymphoblastic leukemia, and progression in the other three cases of B-cell chronic lymphoblastic leukemia. Four patients received regular chemotherapy, and two of them obtained a reduction in serum creatinine levels, but the other two showed no improvement in renal function.ConclusionKidney injury in leukemia commonly manifests as acute kidney injury clinically, acute interstitial nephritis pathologically, and may be complicated by secondary glomerulopathy. Prompt renal biopsy, especially immunohistochemical staining for renal interstitial infiltrating cells, may be helpful for accurate diagnosis and appropriate treatment guidance.