Acute Renal Failure: A Rare Initial Presentation of Acute Lymphoblastic Leukemia

Bordbar, Mohammadreza; Shakibazad, Nader; Mottaghipisheh, Hadi; Shahriari, Mahdi; Zareifar, Soheila; Zekavat, Omid Reza

doi:10.30476/mejc.2020.78666.0

Acute Renal Failure: A Rare Initial Presentation of Acute Lymphoblastic Leukemia

Document Type : Case Report(s)

Authors

Mohammadreza Bordbar ¹

Nader Shakibazad ¹^{, 2}

Hadi Mottaghipisheh ³

Mahdi Shahriari ³

Soheila Zareifar ¹

Omid Reza Zekavat ¹

¹ Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

² Department of Pediatric Hematology and Oncology, Bushehr University of Medical Sciences, Bushehr, Iran

³ Department of Pediatrics, Division of Pediatric Hematology and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran

https://doi.org/10.30476/mejc.2020.78666.0

Abstract

Acute lymphoblastic leukemia has several presentations associated with bone marrow and extramedullary involvement. The unusual presentation may be due to the infiltration of leukemic cells in any organ. An 11-year-old girl presented with fever and vomiting, since one day before admission after starfish biting during swimming. Her vital signs were: blood pressure 150/100 mmHg, pulse 98 beats per minute, respiration 18 breathes per minute, and temperature 37.2 °C (99 F). Laboratory work-up showed blood urea nitrogen 38 mg/dl and creatinine 2.8 mg/dl. In peripheral blood smear, few atypical cells, mild anemia (Hb: 9.2 g/dl), and mild thrombocytopenia (Platelet: 109,000/μL) were detected. Bone marrow aspiration and immunophenotyping were in favor of acute precursor B cell type lymphoblastic leukemia. The patient had a favorable response to treatment after initiating high-risk chemotherapy. Therefore, acute renal failure can be a rare initial presentation of acute lymphoblastic leukemia, and azotemia will improve with an early chemotherapy treatment.

Keywords

Renal failure

Acute lymphocytic leukemia

Precursor B-cell lymphoblastic leukemia

Azotemia

How to cite this article:

Bordbar M, Shakibazad N, Mottaghipisheh H, Shahriari M, Zareifar S, Zekavat OR. Acute renal failure: A rare initial presentation of acute lymphoblastic leukemia. Middle East J Cancer. 2020;11(4): 512-5. doi: 10.30476/mejc.2020. 78666.0.

1. Cooper SL, Brown PA. Treatment of pediatric acute lymphoblastic leukemia. Pediatr Clin North Am. 2015 Feb;62(1):61-73.

2. Inaba H, Greaves M, Mullighan CG. Acute lymphoblastic leukaemia. Lancet. 2013 Jun 01;381(9881):1943-55.

3. Hunger SP, Mullighan CG. Acute Lymphoblastic Leukemia in Children. N Engl J Med. 2015 Oct 15;373(16):1541-52.

4. Sadawaite S, Jijina F, Nair CK, Seth S, Ghosh K. An unusual presentation of pediatric acute lymphoblastic leukemia. Indian J Hematol Blood Transfus. 2008 Jun;24(2):59-62.

5. Asdahl PH, Warner LF, Bendix K, Hasle H. Acute renal failure and normal blood count: A rare presentation of T-cell acute lymphoblastic leukemia. Leuk Res Rep. 2014;3(1):14-6.

6. Bhatia NG, Sneha LM, Selvan SM, Scott JJ. Acute renal failure as an initial manifestation of acute lymphoblastic leukemia. Indian J Nephrol. 2013 Jul;23(4):292-3.

7. Daly GF, Barnard EB, Thoreson L. Renal Calculi: An Unusual Presentation of T-Cell Acute Lymphoblastic Leukemia. Pediatrics. 2016 Jan;137(1).

8. Martins A, Cairoli H, Domínguez P, Martin S, Ortiz C, Potasznik J, et al. [Nephromegaly: as unusual presentation of acute lymphoblastic leukemia in an infant]. Arch Argent Pediatr. 2008 Jun;106(3):263-5.

9. Marwaha RK, Kulkarni KP. Hematuria and renal involvement at presentation in acute lymphoblastic leukemia. Saudi J Kidney Dis Transpl. 2012 Sep;23(5):1088-9.

10. Jones DP, Stapleton FB, Kalwinsky D, McKay CP, Kellie SJ, Pui CH. Renal dysfunction and hyperuricemia at presentation and relapse of acute lymphoblastic leukemia. Med Pediatr Oncol. 1990;18(4):283-6.