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Kidney diseases associated with haematological cancers

Nature Reviews Nephrology volume 11, pages 478–490 (2015)Cite this article

Subjects

Key Points

  • Kidney disorders associated with haematological malignancies can result from the disease process itself, complications of therapy or direct toxicity of chemotherapeutic agents

  • New therapies for haematological malignancies are associated with renal toxicity, which is not commonly seen with older treatment regimens

  • Acute kidney injury is common among patients with multiple myeloma, leukaemia or lymphoma, and negatively influences the prognosis of these patients

  • Glomerular diseases are rare manifestations of haematological malignancies, can precede or follow diagnosis of the malignancy, and can have a wide range of histopathological features

  • Volume expansion and lowering of serum uric acid can prevent the consequences of tumour lysis syndrome; once the condition is established, close attention must be paid to life-threatening acid–base and electrolyte disorders

  • Chronic kidney disease has emerged as an important consequence of haematopoietic stem cell and bone marrow transplantation

Abstract

Advances in chemotherapy for haematological malignancies, resulting from a greater understanding of the complex pathophysiology of these diseases, have improved the survival of patients with these disorders. Clinicians must now, therefore, be more aware of the issues related to fluid, electrolyte, and acid–base disorders, as well as acute and chronic kidney injuries that can develop in such patients as a result of the underlying malignancy and its treatment. Patients with acute kidney injury associated with haematological malignancy have a worse prognosis than do other patients with acute kidney injury. Glomerular diseases associated with haematological malignancies are thought to be paraneoplastic syndromes with variable histological presentations. Some of the newest therapeutic agents used to treat haematological malignancies have adverse renal effects that can preclude continuation of treatment, often leading to difficult clinical decisions when patients have advanced disease and alternative treatment options are limited. Haematopoietic stem cell transplantation has an expanding role as a therapy for haematological malignancies but is also associated with important renal complications. Here, we review the literature that examines the incidences, aetiologies, mechanisms and treatment options for renal disorders associated with haematological malignancies.

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Figure 1: Reported incidence of tumour lysis syndrome associated with different haematological malignancies.
Figure 2: Metabolic pathways involved in uric acid metabolism and tumour lysis syndrome.
Figure 3: Patterns of glomerular injury with haematological malignancies.

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Authors and Affiliations

  1. Renal–Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Founders Pavilion, 3400 Spruce Street, Philadelphia, 19104, PA, USA

    Anirban Ganguli, Deirdre Sawinski & Jeffrey S. Berns

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  1. Anirban Ganguli
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A.G. researched data for the article and wrote the article. D.S. and J.S.B. made substantial contributions to discussion of the content and reviewed and/or edited the manuscript before submission.

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Correspondence to Jeffrey S. Berns.

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Ganguli, A., Sawinski, D. & Berns, J. Kidney diseases associated with haematological cancers. Nat Rev Nephrol 11, 478–490 (2015). https://doi.org/10.1038/nrneph.2015.81

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