-Case Reports-

Primary Tumor Infiltration and Severe Acute Kidney Injury in Patients with Acute Myeloblastic Leukemia

Sae Aratani¹, Sho Aburakawa¹, Tsuyoshi Ryotokuji², Atsushi Marumo², Yukinao Sakai¹, Koiti Inokuchi² and Shuichi Tsuruoka¹

¹Department of Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
²Department of Hematology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan

In patients with hematologic malignancies, acute kidney injury (AKI) is the most common kidney complication requiring nephrologist consultation. Although the causes of AKI are multifactorial, primary tumor infiltration is rare in patients with acute myeloblastic leukemia (AML). This makes it challenging to determine the cause of AKI and the optimal chemotherapy regimen for AML. We describe two cases of AML (French-American-British classification: M2, M4) in patients with AKI requiring hemodialysis. We successfully identified the cause of AKI as primary leukemic infiltration and started induction chemotherapy in the setting of hemodialysis. This treatment significantly improved renal function and resulted in AML remission. In this report, we describe several clinical characteristics of AKI due to primary tumor infiltration. In addition, we emphasize the importance of onconephrology, a new subspecialty concerned with the complex relationship between the kidneys and cancer.

J Nippon Med Sch 2020; 87: 43-48

Keywords
acute kidney injury, acute myeloblastic leukemia, tumor infiltration, onco-nephrology, chemotherapy

Correspondence to
Sae Aratani, Department of Nephrology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
sae-aratani@nms.ac.jp

Received, May 31, 2019
Accepted, November 14, 2019