Nephrotic syndrome as the first manifestation of Acute Myelogenous leukemia

Abstract

The hematological malignancies associated with nephrotic syndrome are mainly hodgkin’s and non-hodgkin’s lymphomas and chronic lymphocytic leukemia. Acute myelogenous leukemia (AML) has rarely been described in associated with nephritic syndrome. We report a rare case of acute myelogenous leukemia who presented with nephrotic syndrome. A previously healthy 62-year-old man was admitted in nephrology ward because of generalized developing pitting edema during last month. Simultaneously, he had generalized itching and urticaria, polyuria, polydypsia and low grade fever but had no history of weight loss, anorexia and sweating. In laboratory tests he had proteinuria above 3.5 gr/ day. Because of anemia, hematology consultation was done. In peripheral blood, there were myeloblast cells in the circulation at a ratio of 20%. Bone marrow aspiration confirmed a diagnosis of AML M2, showing hypercellular bone marrow with 80-90% leukemic cells, increased M/E ratio, myeloblast (immature cell, fine chromatin, cytoplasmic granule) and these abnormal elements: myeloblast >50% and mature cell about 20%. Unfortunately, we hadn’t renal biopsy as a consequent of patient illness and thrombocytopenia. He received induction chemotherapy, which led to a complete remission and decreasing urinary protein excretion during chemotherapy and no proteinurai at the end of it. Now the patient has received second course of consolidation therapy and remained in complete remission, with no physical and laboratory evidence of proteinuria. It can be concluded that nephrotic syndrome may be additionally associated with AML. In some cases, there is a direct causal effect of the leukemic process on renal function or even pathology, while in others it is exerted indirectly via other complications of the malignancy or the treatment.