Renal manifestations at initial diagnosis of childhood acute leukemias: a retrospective analysis from a single center

Abstract

BACKGROUND: We aimed to investigate the frequency of ultrasonographic renal pathology and disorders of the renal system in children with newly diagnosed acute leukemia. METHODS: The clinical records of 177 patients were evaluated retrospectively. RESULT S: Eighty-three patients were females, 94 were males. The mean age at diagnosis was 6.3 +/- 4.1 years, 81.4% had B-cell lineage acute lymphoblastic leukemia (ALL), 10.2% T-cell lineage ALL, 7.3% acute myeloblastic leukemia, 1.1% mixt lineage leukemia. In 18.6% renal pathologic findings were detected in ultrasonographic evaluation. Bilateral nephromegaly was identified in 9%, unilateral nephromegaly in 2.3%, parenchymal pathology without nephromegaly in 7.3%, bilateral medullary nephrocalcinosis in 1.7%. Uric acid was >= 8 mg/dL in 9%, potassium was >= 6 in 0.6%, phosphorus was >= 6.5 in 2.3%, calcium was >= 7 in 0.6%. Spontaneous laboratory tumor lysis syndrome developed in 0.6%. There was no statistically significant difference between leukemia lineages in terms of nephromegaly and renal parenchymal pathology (P>0.05). There was no statistically significant difference between patients with and without renal findings in terms of leukemia lineage, white blood cells, hemoglobin, platelet, lactate dehydrogenase, potassium, calcium, phosphorous values (P>0.05). Mean uric acid and mean creatinine were significantly higher in patients with ultrasonographic renal pathology (P<0.05, P<0.05, respectively). CONCLUSIONS: Renal manifestations and metabolic disturbances are important in the presentation of acute childhood leukemias. High awareness must be paid to avoid delays in the management of these metabolic disturbances and to decrease morbidity rates at the initial diagnosis of these children.