[Interstitial nephritis developed during maintenance chemotherapy in a child with acute lymphocytic leukemia].
Yoshihito MoriokaShinsaku ImashukuAkane MizutaniKoichi SakataTakao YoshiharaSatoshi IkushimaHidekazu KawakatsuShinjiro Todo
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Nephritis
Interstitial nephritis
Maintenance therapy
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Objective To investigate the methods of nurse for chemotherapy to children with Acute Lymphocytic leukemia,to avoid and reduce the side effect and complication for chemotherapy,and to raise the effect of therapy.Methods The experience from 21 cases of children with acute lymphocytic leukemia was summarized.Results The side effect and complication were controlled promptly and effectively,and the effective rate was 85.7%.Conclusion The fine nurse job was an important factor,which can ensure the successful chemotherapy to children with acute lymphocytic leukemia.
Acute lymphocytic leukemia
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Twenty individuals developed acute non-lymphocytic leukemia (ANLL) following long-term chemotherapy for other disorders. The primary disorders included non-Hodgkin's lymphoma (five), Hodgkin's disease (five), carcinoma (four), multiple myeloma (three), chronic lymphocytic leukemia (two), and rheumatoid arthritis. Leukemia developed from 11–132 months (mean approximately 60 months) following institution of chemotherapy and all cases have occurred since 1974. Pre-leukemic cytopenias were present in 15 individuals. Fifteen of the 20 patients had chromosome analyses and 14 were abnormal. The leukemia was invariably refractory to chemotherapy with a median survival of only two months. Of the patients autopsied, only one individual had any evidence of the primary malignancy. This study illustrates the need for surveillance for secondary ANLL following long-term chemotherapy with/ without radiotherapy. Duration of optimal chemotherapy for the primary disease must be determined by control trials and weighed against the risk of developing a secondary leukemia.
Acute lymphocytic leukemia
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Interstitial nephritis
Nephritis
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Among chemotherapeutic regimens used for advanced ovarian cancer, platinum-based combination chemotherapy remains a mainstay of the treatment of advanced ovarian cancer, providing significant response rates and survival benefits. However, with widespread use of longterm chemotherapy in treating ovarian cancer, emergence of secondary leukemia has become medical concern as one of the most unfavorable late complications. Depending upon the type, duration, and dosage of previous chemotherapy, the risk of developing acute myeloid leukemia has been estimated to be between 2% and 10%. Moreover, the frequency of this complication might increase as the survival in patients with ovarian cancer undergoing chemotherapy continues to increase with developing therapeutic options. Recently, we experienced a case of secondary acute myeloid leukemia developing 3.5 years after platinum-based chemotherapy. In this report, clinical course of the patient and contributing factors for the secondary leukemia were presented.
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Renal failure due to the infiltration of chronic lymphocytic leukemia (CLL) cells into the tubulointerstitial area of the kidney is uncommon. Furthermore, granulomatous interstitial nephritis (GIN) is a rare histological diagnosis in patients undergoing a renal biopsy. We herein report a case of GIN due to the diffuse infiltration of CLL cells in a patient who developed progressive renal failure. The patient was a 55-year-old man who had been diagnosed with CLL 4 years earlier and who had been followed up without treatment. Although his serum creatinine level had remained normal for three and a half years, it started to increase in the six months prior to his presentation. A urinalysis showed mild proteinuria without any hematuria at the time of presentation. A renal biopsy revealed the diffuse infiltration of CLL cells into the tubulointerstitial area with non-caseating epithelioid cell granulomas. Despite cyclophosphamide treatment, his renal function did not improve, and he ultimately required maintenance hemodialysis. When progressive renal failure is combined with CLL, GIN due to the direct infiltration of CLL cells should be considered as a differential diagnosis.
Nephrology
Interstitial nephritis
Infiltration (HVAC)
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Cimetidine
Interstitial nephritis
Nephritis
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Renal dysfunction is uncommon in patients with leukemic infiltration of the kidney due to Chronic Lymphocytic Leukanemia (CLL). Granulomatous interstitial nephritis (GIN) is also rare, but a characteristic hallmark of certain diseases such as sarcoidosis and tuberculosis. GIN has been associated with medications, infections, inflammation, Wegener's granulomatosis, and jejuno-ileal bypass. GIN combined with leukemic infiltration by CLL is very uncommon. We present a 72-year-old male with Binet stage A CLL who developed progressive renal failure over a period of four years requiring maintenance dialysis. During the course of his illness, he underwent renal biopsies at different time intervals, revealing varying degrees of involvement by GIN together with leukemic infiltration.
Interstitial nephritis
Infiltration (HVAC)
Nephritis
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Several weeks after reading the interesting article, Acute Interstitial Nephritis in Children: A Report of 13 Cases and Review of the Literature (Ellis D, Fried WA, Yunis EJ, et al: Pediatrics 67:862, 1981), a 10-year old girl was admitted to our Department with a history of five days9 fever [100.1 to 100.2 F (37.8 to 37.9 C)], progressive fatigue, anorexia, diffuse abdominal pain, and vomiting. The mother noticed, one day prior to her admission, a decreased urinary output.
Anorexia
Interstitial nephritis
Girl
Nephritis
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Concomitant
Nephritis
Interstitial nephritis
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Acute myelocytic leukemia occurring many years after intensive radiotherapy and/or chemotherapy has been reported in 82 patients with Hodgkin's disease, 58 patients with multiple myeloma, and 40 patients with chronic lymphocytic leukemia. The precise incidence of this occurrence is uncertain, since the total number of patients at risk is unknown. Most patients with Hodgkin's disease had received intensive radiation therapy. Many also received chemotherapy. One-third of the patients with myeloma were treated only with melphalan. Acute leukemia may occur as part of the natural history of Hodgkin's disease and multiple myeloma; it has been seen with increasing frequency in recent years due to improved survival secondary to better treatment. It is also possible that radiotherapy and/or chemotherapy may be causally related to the development of acute leukemia.
Melphalan
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