Abstract
Although many authors have commented on the frequency of parenchymal infiltration of the kidneys in leukemia, such a case as with strikingly enlarged kidneys is rare, and there has to date been no systematic study of kidney function during the course of leukemia.
This paper reports a case of 12-year-old boy with acute leukemia accompanied by enlarged kidneys and gross impairment of renal function.
On the first admission, Feb. 27, 1967, his main symptoms were non-tender enlargement of the bilateral cervical lymph nodes and of the hilar lymph nodes on a chest film. The liver, spleen and kidneys were not palpable. Evidence of leukemia was not revealed except the bone marrow smears. A cervical lymph node biopsy was verified as “malignant lymphoma”. A total of 700 r in air was given over the bilateral enlarged cervical nodes, and cervical, hilar nodes markedly reduced. And then, both steroids and 6-mercaptopurine, for the treatment of aleukemic leukemia, were given to the patient with prominent improvement. No significant proteinuria was noted. The phenolsulfonphthalein test revealed 23 per cent excretion of injected dye in 15 minutes and 65 percent total in 2 hours. Renal plasma flow in the renal clearance test was slightly diminished. The decrease in RPF was significantly greater than that in GFR. The serum level of nonprotein nitrogen was 26.5 mg/dl.
The patient was in good health until June, 1967, when he developed a right facial palsy, the second time enlargement of hilar lymph nodes and obvious hepatosplenomegaly. In the peripheral blood and bone marrow, vacuolated immature leukemic cells were seen. An intravenous urograms demonstrated very large bilateral homogeneous masses compatible with enlarged kidneys, and the collecting system was faintly visualized on either side. The phenolsulfonphthalein test showed 0.5 per cent in 15 minutes and 17.0 per cent total in 2 hours. The glomerular filtration rate was greatly reduced to 7 ml per minute, and the renal plasma flow was also reduced to 27 ml per minute. Thus the filtration fraction was reduced. The serum level of nonprotein nitrogen was elevated to 124.6 mg/dl. as a passing phenomenon. The radiohippuran renogram showed non-functioning type which pointed out serious functional loss of kidneys. A large volume of dilute urine and low specific gravity of the urine were observed. Hematuria and proteinuria were not seen. Besides, in liver function test, there was correlation with the extent of the reduction of renal function. The SGOT, SPGT and LDH were over normal limits.
The patient died of intestinal bleeding on Sept. 12, 1967. The relations between renal involvement and the appearance of vocuolated leukemic cells in the blood and bone marrow smears are to be noted.
