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Late acute renal failure due to bilateral kidney infiltration by ALL as single manifestation of relapse after allogeneic transplantation

Bone Marrow Transplantation volume 45, pages 953–954 (2010)Cite this article

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Acute renal failure (ARF) is a common complication following allogeneic hematopoietic SCT (HSCT). Numerous conditions may be associated with early ARF including pre-existing kidney dysfunction, hypertension, TBI, sepsis, sinusoidal occlusion syndrome, dehydration, acute GVHD, nephrotoxic drugs and microangiopathic syndromes, which include both thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. The incidence of microangiopathic syndromes ranges from 2 to 21% after allogeneic HSCT, and identified primary risk factors include TBI and use of calcineurin inhibitors. Clinically, thrombotic thrombocytopenic purpura tends to occur early, often within the first 90 days of transplant, whereas hemolytic uremic syndrome seems to occur much later.1 Direct malignant infiltration of the kidneys at diagnosis of acute leukemia is an extremely rare cause of early ARF and has been described in a few children only.2, 3

Calcineurin inhibitor toxicity remains among the most common causes of late ARF. CsA and tacrolimus are both potent vasoconstrictors of the glomerulus afferent arteriole and known to cause various damages, including arteriolar injury, glomerular sclerosis and interstitial fibrosis as well as diffuse expansion of the mesangial matrix. An unusual cause of late ARF includes radiation nephritis, which may present acutely, 6–12 months after irradiation or late, 2–5 years later. Rarely, late ARF has been associated with membranous nephropathy, a manifestation of chronic GVHD. Diffuse proliferative glomerulonephritis, antineutrophil cytoplasmic Ab-related glomerulo-nephritis, focal segmental glomerulosclerosis and Ig A nephropathy have been described as well in association with chronic GVHD.4 We describe herein the first case of an adult patient presenting with late ARF because of bilateral kidney involvement by ALL several months after allogeneic HSCT.

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Authors and Affiliations

  1. Blood and Marrow Transplant Program, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, Quebec, Canada

    M Detrait, D-C Roy, T Kiss, S Lachance, S Cohen, L Busque, G Sauvageau & J Roy

  2. Department of Pathology, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, Quebec, Canada

    C Meunier

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  1. M Detrait
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  2. C Meunier
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  3. D-C Roy
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  4. T Kiss
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  7. L Busque
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Correspondence to M Detrait.

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Detrait, M., Meunier, C., Roy, DC. et al. Late acute renal failure due to bilateral kidney infiltration by ALL as single manifestation of relapse after allogeneic transplantation. Bone Marrow Transplant 45, 953–954 (2010). https://doi.org/10.1038/bmt.2009.246

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