Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Acute lymphoblastic leukemia presenting as acute renal failure

Nature Clinical Practice Nephrology volume 3, pages 106–110 (2007)Cite this article

Abstract

Background A 42-year-old previously healthy man presented with acute-onset headache and facial paralysis. He was treated for Bell's palsy with corticosteroids and valaciclovir. One week later, he developed acute renal failure requiring hospitalization.

Investigation Physical examination, laboratory tests, urinalysis, renal ultrasound, renal biopsy, bone marrow biopsy, lumbar puncture, CT of the chest, abdomen and pelvis, MRI of the brain, and whole-body PET scan.

Diagnosis Acute lymphoblastic leukemia, bilateral renal enlargement secondary to leukemic infiltration, acute renal failure, tumor lysis syndrome, and leukemic involvement of the facial nerve.

Management The patient was treated with a modified induction chemotherapy regimen. He was given allopurinol for hyperuricemia and hydrated with alkalized intravenous fluids to prevent uric acid precipitation in the renal tubules. The profound tumor lysis that occurred after the cytotoxic chemotherapy required hemodialysis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Renal biopsy findings of the patient.

References

  1. Kirshbaum JD and Preuss FA (1943) Leukemia, a clinical and pathological study of 123 fatal cases in a series of 14,400 necropsies. Arch Intern Med 71: 777–792

    Article  Google Scholar 

  2. Sullivan MP and Hrgovcic CM (1973) Extramedullary leukemia. In Clinical Pediatric Oncology, 227–251 (Eds Sutow WW et al.) St Louis: MO Mosby

    Google Scholar 

  3. Moudgil A et al. (1989) Acute renal failure due to renal infiltration with lymphoreticular malignant cells. Indian Pediatr 26: 830–832

    CAS  PubMed  Google Scholar 

  4. Dzierzak E (1999) Embryonic beginnings of definitive hematopoietic stem cells. Ann NY Acad Sci 872: 256–262

    Article  CAS  Google Scholar 

  5. Ohneda O et al. (1998) Hematopoietic stem cell maintenance and differentiation are supported by embryonic aorta-gonad-mesonephros region-derived endothelium. Blood 92: 908–919

    CAS  PubMed  Google Scholar 

  6. Sato A et al. (2004) Acute renal failure due to leukemic cell infiltration followed by relapse at multiple extramedullary sites in a child with acute lymphoblastic leukemia. Leuk Lymphoma 45: 825–828

    Article  Google Scholar 

  7. Hoelzer D (1991) Acute lymphoblastic leukemia in adults. In Hematology: Basic Principles and Practice, 793–804 (Ed Hoffman R) New York: Churchill Livingstone

    Google Scholar 

  8. Lundberg WB et al. (1977) Renal failure secondary to leukemic infiltration of the kidneys. Am J Med 62: 636–642

    Article  CAS  Google Scholar 

  9. Baringer JR (1996) Herpes simplex virus and Bell palsy. Ann Intern Med 124: 63–65

    Article  CAS  Google Scholar 

  10. Duzova A et al. (2001) Acute tumour lysis syndrome following a single-dose corticosteroid in children with acute lymphoblastic leukaemia. Eur J Haematol 66: 404–407

    Article  CAS  Google Scholar 

  11. Vaisban E et al. (2001) Acute tumor lysis syndrome induced by high-dose corticosteroids in a patient with chronic lymphatic leukemia. Ann Hematol 80: 314–315

    Article  CAS  Google Scholar 

  12. Rajagopal S et al. (1992) Corticosteroid induced tumor lysis syndrome in acute lymphoblastic leukemia. Am J Hematol 41: 66–67

    Article  CAS  Google Scholar 

  13. Tiley C et al. (1992) Tumour lysis following hydrocortisone prior to a blood product transfusion in T-cell acute lymphoblastic leukaemia. Leuk Lymphoma 8: 143–146

    Article  CAS  Google Scholar 

  14. Kelton J et al. (1978) A rapid method for the diagnosis of acute uric acid nephropathy. Arch Intern Med 138: 612–615

    Article  CAS  Google Scholar 

  15. Filippatos TD et al. (2005) Alterations in electrolyte equilibrium in patients with acute leukemia. Eur J Haematol 75: 449–460

    Article  CAS  Google Scholar 

  16. Hann IM et al. (1981) Renal size as a prognostic factor in childhood acute lymphoblastic leukemia. Cancer 48: 207–209

    Article  CAS  Google Scholar 

  17. D'Angelo P et al. (1995) Prognostic value of nephromegaly at diagnosis of childhood acute lymphoblastic leukemia. Acta Haematol 94: 84–89

    Article  CAS  Google Scholar 

  18. Neglia JP et al. (1988) Kidney size at diagnosis of childhood acute lymphocytic leukemia: lack of prognostic significance for outcome. Am J Pediatr Hematol Oncol 10: 296–300

    Article  CAS  Google Scholar 

  19. Mathe G et al. (1966) Extensive histological and cytological survey of patients with acute leukaemia in “complete remission”. Br Med J 1: 640–642

    Article  CAS  Google Scholar 

  20. Chua CC et al. (1988) Use of polyethylene glycol-modified uricase (PEG-uricase) to treat hyperuricemia in a patient with non-Hodgkin lymphoma. Ann Intern Med 109: 114–117

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. WM Suh is a clinical instructor/hospitalist in the Department of Medicine, ZA Wainberg is a postdoctorate fellow and S de Vos is Assistant Professor in the Division of Hematology and Oncology, and I Kurtz is Professor of Medicine and Division Chief and MK Nguyen is Associate Clinical Professor in the Division of Nephrology, all at the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,

    William M Suh, Zev A Wainberg, Sven de Vos, Ira Kurtz & Minhtri K Nguyen

  2. AH Cohen is Professor of Pathology and Medicine at Cedars–Sinai Medical Center, Los Angeles, CA, USA.,

    Arthur H Cohen

Authors
  1. William M Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zev A Wainberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sven de Vos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arthur H Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ira Kurtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Minhtri K Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William M Suh.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Suh, W., Wainberg, Z., de Vos, S. et al. Acute lymphoblastic leukemia presenting as acute renal failure. Nat Rev Nephrol 3, 106–110 (2007). https://doi.org/10.1038/ncpneph0400

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneph0400

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing