Anuric Acute Kidney Injury in Chronic Myeloid Leukemia: A Rare Complication Case

Angela Kimberly Tjahjadi, Artaria Tjempakasari

Abstract


This report describes a rare case of anuric acute kidney injury related to suspected urate nephropathy in a 23-year-old male with chronic phase of Chronic Myeloid Leukemia (CML). The patient presented with anuria and limb edema, with a history of imatinib-treated CML. Investigations revealed probable urate crystals causing bilateral hydronephrosis and hydroureters. Management included fluid restriction to maintain euvolemic status, hypouricemic agents, urinary alkalinization, urgent hemodialysis for acute kidney injury, and blood product transfusions to address haematological imbalances. The continued use of imatinib and aforementioned treatments resulted in the restoration of renal function depicted through normalization of serum urea, creatinine and uric acid levels. This case highlights the importance of meticulous assessment and management of anuric acute kidney injury in CML patients to ensure a positive outcome.


Keywords


anuria; acute kidney injury; chronic myeloid leukemia

References


Loscocco F, Visani G, Galimberti S, Curti A, Isidori A. BCR-ABL independent mechanisms of resistance in chronic myeloid leukemia. Frontiers in Oncology [Internet]. 2019 [cited 2023 Sep 13];9. Available from: https://www.frontiersin.org/articles/10.3389/fonc.2019.00939

Deininger MW, Shah NP, Altman JK, et al. Chronic myeloid leukemia, Version 2.2021, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network [Internet]. 2020 Oct 1 [cited 2023 Sep 12];18(10):1385–415. Available from: https://jnccn.org/view/journals/jnccn/18/10/article-p1385.xml

Ahmed AA, Khaleel KJ, Fadhel AA, Al-Rubaii BAL. Chronic myeloid leukemia: A retrospective study of clinical and pathological features. RB [Internet]. 2022 Sep 15 [cited 2023 Sep 21];7(3):1–3. Available from: https://www.revistabionatura.com/2022.07.03.41.html

Kantarjian H, Jabbour E, Cortes J. Chronic myeloid leukemia. In: Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s principles of internal medicine. 21st edition. New York: McGraw Hill; 2022.

Bintoro SUY, Romadhon PZ, Suryantoro SD, Aminy RZ, Windradi C, Widiyastuti KN. Case report: Priapism as the clinical presenting feature of chronic myeloid leukemia: Case report and 20-year literature review. F1000Res. 2021;10:571.

Suprapti B, Andarsari MR, Hapsari PP, Khotib J, Suharjono, Bintoro SUY. Relationship between trough level of tyrosine kinase inhibitor (imatinib and nilotinib) and BCR-ABL ratios in an Indonesian chronic-phase chronic myeloid leukemia (CML) population. Journal of Basic and Clinical Physiology and Pharmacology [Internet]. 2020 Sep 1 [cited 2024 Feb 3];31(5). Available from: https://www.degruyter.com/document/doi/10.1515/jbcpp-2019-0315/html

Shah NP, Bhatia R, Altman JK, et al. Chronic myeloid leukemia, Version 1.2024, NCCN Clinical Practice Guidelines in Oncology [Internet]. National Comprehensive Cancer Network; 2023 [cited 2023 Sep 12]. Available from: https://jnccn.org/view/journals/jnccn/18/10/article-p1385.xml

Kitchlu A, McArthur E, Amir E, et al. Acute kidney injury in patients receiving systemic treatment for cancer: A population-based cohort study. J Natl Cancer Inst. 2019;111(7):727–36.

Rosner MH, Perazella MA. Acute kidney injury in the patient with cancer. Kidney Res Clin Pract [Internet]. 2019 Sep [cited 2023 Nov 4];38(3):295–308. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727896/

Luciano RL, Brewster UC. Kidney involvement in leukemia and lymphoma. Advances in Chronic Kidney Disease [Internet]. 2014 Jan 1 [cited 2023 Nov 3];21(1):27–35. Available from: https://www.sciencedirect.com/science/article/pii/S1548559513000967

Bridoux F, Cockwell P, Glezerman I, et al. Kidney injury and disease in patients with haematological malignancies. Nat Rev Nephrol [Internet]. 2021 Jun [cited 2023 Nov 3];17(6):386–401. Available from: https://www.nature.com/articles/s41581-021-00405-7

Aydın Ö, Kaynar K, Güvercin B. Membranous glomerulopathy secondary to chronic myeloid leukemia. Hippokratia [Internet]. 2021 [cited 2023 Sep 17];25(4):175–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894302/

Talwar R, Dash SC, Kucheria K. A case of chronic myeloid leukemia complicated with minimal change nephrotic syndrome. Acta Haematol. 2003;109(2):101–3.

Hustrini NM, Susalit E, Lydia A, et al. The etiology of kidney failure in Indonesia: A multicenter study in tertiary-care centers in Jakarta. Ann Glob Health [Internet]. 2023 Jun 1 [cited 2023 Nov 5];89(1):36. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10237240/

Mohanavelu P, Mutnick M, Mehra N, et al. Meta-analysis of gastrointestinal adverse events from tyrosine kinase inhibitors for chronic myeloid leukemia. Cancers [Internet]. 2021 Jan [cited 2023 Nov 5];13(7):1643. Available from: https://www.mdpi.com/2072-6694/13/7/1643

Pappa E, Gkeka M, Kiki II I, Gourna P, Christopoulos C. Diuretic-resistant ascites following laparoscopic surgery in a patient with chronic myeloid leukemia on imatinib therapy. Cureus. 2021;13(2).

Ren X, Qin Y, Huang X, Zuo L, Jiang Q. Assessment of chronic renal injury in patients with chronic myeloid leukemia in the chronic phase receiving tyrosine kinase inhibitors. Ann Hematol [Internet]. 2019 Jul 1 [cited 2023 Nov 4];98(7):1627–40. Available from: https://doi.org/10.1007/s00277-019-03690-2

Stanchina M, McKinnell Z, Park JH, Stein EM, Cai SF, Taylor J. BCR-ABL tyrosine kinase inhibitor (TKI)-induced nephropathy: An under-recognized phenomenon. Leukemia Research Reports [Internet]. 2020 Jan 1 [cited 2023 Sep 17];14:100211. Available from: https://www.sciencedirect.com/science/article/pii/S2213048920300170

Yesil EE, Sit D, Kayabasi H, Zerenler Gursoy F, Demirbas MB, Ocak Serin S. A case of dasatinib-induced focal segmental glomerulosclerosis in a patient with Philadelphia chromosome positive chronic myeloid leukemia. Néphrologie & Thérapeutique [Internet]. 2021 Feb 1 [cited 2023 Sep 17];17(1):53–6. Available from: https://www.sciencedirect.com/science/article/pii/S1769725520303850

Yilmaz M, Lahoti A, O’Brien S, et al. Estimated glomerular filtration rate changes in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors. Cancer. 2015;121(21):3894–904.

Gu X, Zhang S, Zhang T. Abnormal crosstalk between endothelial cells and podocytes mediates tyrosine kinase inhibitor (TKI)-induced nephrotoxicity. Cells [Internet]. 2021 Apr [cited 2023 Sep 17];10(4):869. Available from: https://www.mdpi.com/2073-4409/10/4/869

Russell TB, Kram DE. Tumor lysis syndrome. Pediatrics In Review [Internet]. 2020 Jan 1 [cited 2023 Sep 17];41(1):20–6. Available from: https://publications.aap.org/pediatricsinreview/article/41/1/20/35342/Tumor-Lysis-Syndrome

Barbar T, Sathick IJ. Tumor lysis syndrome. Advances in Chronic Kidney Disease [Internet]. 2021 Sep 1 [cited 2023 Sep 19];28(5):438-446.e1. Available from: https://www.sciencedirect.com/science/article/pii/S1548559521000963

Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011 May 12;364(19):1844–54.

Strauss PZ, Hamlin SK, Dang J. Tumor lysis syndrome. Nursing Clinics of North America [Internet]. 2017 Jun [cited 2023 Sep 17];52(2):309–20. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0029646517300191

Hajjar AHW, Abbarh S, Al-Mashdali A, et al. Tumor lysis syndrome in the chronic phase of chronic myeloid leukemia following COVID-19 infection: A case report. Cureus [Internet]. 2022 Apr 22 [cited 2023 Sep 17]; Available from: https://www.cureus.com/articles/92474-tumor-lysis-syndrome-in-the-chronic-phase-of-chronic-myeloid-leukemia-following-covid-19-infection-a-case-report

Liaqat S, Marwat A, Hussain M. Spontaneous tumor lysis syndrome in myeloproliferative disorder: A rarely reported clinical entity. AJMCR [Internet]. 2020 Jul 3 [cited 2023 Sep 19];8(10):361–2. Available from: http://pubs.sciepub.com/ajmcr/8/10/10/index.html

Al-Mashdali AF, Yassin MA. Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase: A case report. Medicine: Case Reports and Study Protocols [Internet]. 2022 Jul [cited 2023 Sep 17];3(7):e0244. Available from: https://journals.lww.com/md-cases/Fulltext/2022/07000/Spontaneous_tumor_lysis_syndrome_in_a_patient_with.1.aspx

Tinawi M. Hypokalemia: A practical approach to diagnosis and treatment. Archives of Clinical and Biomedical Research [Internet]. 2020 Apr 13 [cited 2023 Nov 5];4(2):48–66. Available from: http://www.fotunejournals.com/hypokalemia-a-practical-approach-to-diagnosis-and-treatment.html

Pochedly C. Hyperuricemia in leukemia and lymphoma. Postgrad Med [Internet]. 1974 Jun 1 [cited 2024 Jan 25];55(6):93–9. Available from: https://doi.org/10.1080/00325481.1974.11713785

Sutherland RW. 45 - Obstructive uropathy. In: Gilbert SJ, Weiner DE, editors. National kidney foundation’ s primer on kidney diseases (Seventh Edition) [Internet]. Philadelphia: Elsevier; 2018 [cited 2024 Jan 25]. p. 412–9. Available from: https://www.sciencedirect.com/science/article/pii/B9780323477949000457

Isaka Y, Takabatake Y, Takahashi A, Saitoh T, Yoshimori T. Hyperuricemia-induced inflammasome and kidney diseases. Nephrology Dialysis Transplantation [Internet]. 2016 Jun 1 [cited 2023 Sep 19];31(6):890–6. Available from: https://doi.org/10.1093/ndt/gfv024

Chen HH, Chien SW, Huang CL, Cheng CJ, Wang TC, Chen PY. Hyperuricemic Acute renal failure in patient with diarrheal dehydration: A case report. Acta Nephrologica. 2002;16(2):79–81.

Pou M, Saval N, Vera M, t al. Acute renal failure secondary to imatinib mesylate treatment in chronic myeloid leukemia. Leukemia & Lymphoma [Internet]. 2003 Jan [cited 2023 Nov 5];44(7):1239–41. Available from: https://www.tandfonline.com/doi/full/10.1080/1042819031000079140

Puri I, Sharma D, Gunturu KS, Ahmed AA. Diagnosis and management of tumor lysis syndrome. Journal of Community Hospital Internal Medicine Perspectives [Internet]. 2020 May 3 [cited 2023 Sep 19];10(3):269–72. Available from: https://doi.org/10.1080/20009666.2020.1761185

Williams SM, Killeen AA. Tumor lysis syndrome. Archives of Pathology & Laboratory Medicine [Internet]. 2018 Nov 30 [cited 2023 Sep 19];143(3):386–93. Available from: https://doi.org/10.5858/arpa.2017-0278-RS

Ostermann M, Liu K, Kashani K. Fluid management in acute kidney injury. Chest [Internet]. 2019 Sep 1 [cited 2023 Nov 5];156(3):594–603. Available from: https://www.sciencedirect.com/science/article/pii/S001236921930830X

Hochhaus A, Saussele S, Rosti G, et al. Chronic myeloid leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology [Internet]. 2017 Jul [cited 2024 Jan 25];28:iv41–51. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0923753419421479

Sharma R, Abrol D, Singh GD, Angurana SL. Febuxostat versus Allopurinol for the prevention and treatment of hyperuricemia in chronic myelogenous leukemia with hyperleucocytosis. 2016;18(1):12–5.

Matuszkiewicz-Rowinska J, Malyszko J. Prevention and Treatment of tumor lysis syndrome in the era of onco-nephrology progress. Kidney and Blood Pressure Research [Internet]. 2020 Sep 30 [cited 2023 Sep 19];45(5):645–60. Available from: https://doi.org/10.1159/000509934


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