ACUTE-RENAL-FAILURE ASSOCIATED WITH THE RETINOIC ACID SYNDROME IN ACUTE PROMYELOCYTIC LEUKEMIA

All-trans-retinoic acid is an effective agent to induce remission in p atients with acute promyelocytic leukemia (APL). Unlike conventional c hemotherapy, this drug exerts its effect by inducing differentiation o f immature leukemic cells. A distinctive clinical syndrome characteriz ed by fever, dyspnea, effusions, weight gain, and organ failure (the ' 'retinoic acid syndrome'') can occur during treatment with this drug, Postmortem studies have shown extensive organ infiltration by leukemic cells, and the early administration of corticosteroids can result in prompt resolution of symptoms. We describe a patient with Apt. in whom acute renal failure developed during treatment with all-trans-retinoi c acid. Transient renal enlargement during a period of leukocytosis an d a beneficial response to treatment with dexamethasone suggest that r enal failure in this patient was probably related to the retinoic acid syndrome. (C) 1996 by the National Kidney Foundation, Inc.