Renal changes in acute leukemia in children at onset. Incidence and prognostic value

Microscopic leukemia infiltration of kidneys is a common autoptic finding in children for ALL before starting specific treatment. However, a palpable renal enlargement is uncommon. The authors have performed an intravenous pyelogram (IVP) in 139 pediatric cases of acute leukemia, 117 of whom ALL, the remaining 22 ANLL. ALL patients were divided in 3 groups; Group 1 was made of 18 children treated with IGG-74 protocol, independently by any prognostic factor; Group 2 included 46 patients presenting one or more negative factors; Group 3 was of 53 cases with no unfavourable factor. Abnormal IVP was found in 4/18 (22,2%) Group 1, 9/46 (19,5%) Group 2, 2/53 (3,8%) Group 3 ALL patients. The most common anomaly was a bilateral renal enlargement with normal or slightly compromised renal function. Only 3 out of 117 ALL children had palpable renal masses. All 15 children acquired CR within one month from starting therapy together with normalization of IVP. Six out of 15 of these cases died, one is alive with disease, 8 are alive in CR. Except for two cases, all presented other negative prognostic factor associated with abnormal IVP. One of 22 ANLL children had an abnormal IVP: only one kidney was involved with the unique mechanism of intraparenchimal hemorrhage and hydronephrosis due to the filling of renal pelvis and ureter by multiple coarse cloths. In conclusions, major renal alterations are present in about 10% of ALL children, rarely in ANLL. This finding is commonly associated with unfavorable prognostic factors.