RENAL COMPLICATIONS IN ACUTE LEUKEMIAS

Background and Objective. Renal failure is a known complication of acu te leukemias both at diagnosis and following cytostatic treatment. No recent studies give data on the incidence and risk factors of renal co mplications and their prognostic impact. Design and Methods. Two hundr ed and twenty consecutive adult patients with newly diagnosed acute le ukemia treated at a major university medical center were evaluated for renal complications before, during, and after treatment; 166 patients were treated by chemotherapy only and 54 patients were treated with c hemotherapy and later transplanted with allogeneic or autologous bone marrow. Renal complications were subdivided into 3 entities: acute ren al failure, major and minor complications, based on clinical and labor atory parameters. Renal failure occurring as a consequence of terminal multi-organ failure was excluded from the present study. Results. App roximately 30% of patients in the chemotherapy group had a renal compl ication either before or after chemotherapy. Patients undergoing trans plantation had a 50% risk of renal complications. Risk factors for com plications were male sex, age, previous kidney disease, white cell cou nt, and refractory leukemia (chemotherapy group) and allogeneic versus autologous transplant (transplant group). In the chemotherapy group, early but not delayed renal complications had a poor prognostic impact . In the transplant group renal complications had no impact on prognos is. In all patient groups, acute renal failure was prognostically unfa vorable. interpretation and Conclusions. We conclude from our study th at renal complications are frequent in acute leukemias and that the tr eatment and prevention of renal complications is important for the man agement of acute leukemias. (C)1998, Ferrata Storti Foundation.