Unusual clinical course, Management of emergency care
Elliot B. Tapper, Katarina Luptakova, Robin M. Joyce, Dimitrios Tzachanis
Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, USA
Am J Case Rep 2014; 15:364-367
Available online: 2014-08-30
Renal failure is a common presentation of acute myelomonocytic and monocytic leukemia. It is usually the result of a combined glomerular and tubular dysfunction and is associated with a poor prognosis. No guidelines exist for treatment.
Case Report: We herein describe the case of a 78-year-old Caucasian man who presented with acute myeloid leukemia M5, leukostasis with a white count of 340 000/ml, and acute renal failure with a creatinine of 7.7/dL. The patient was initially treated with leukapheresis and 3 days of idarubicin in the setting of continuous renal replacement therapy that resulted in rapid reversal of his renal failure. He then received 7 days of continuous infusion cytarabine and went into a complete remission.
Conclusions: Renal failure may complicate the presentation of AML but can be reversible with treatment. Dose adjustment of the chemotherapy is not needed and the treatment can be greatly facilitated with the use of continuous renal replacement therapy, as indicated in our case report. In addition, we emphasize that organ dysfunction, even in elderly patients, is not necessarily a contraindication to aggressive treatment if it is felt to be disease-related and reversible.
Keywords: Antineoplastic Agents - therapeutic use, Acute Kidney Injury - therapy, Diagnosis, Differential, Follow-Up Studies, Leukapheresis, Leukemia, Myeloid, Acute - therapy, Renal Dialysis - methods