From the Guidelines
Acute Myeloid Leukemia (AML) can significantly impact kidney function, primarily through indirect mechanisms such as tumor lysis syndrome, rather than direct kidney infiltration. When considering the relationship between AML and kidney function, it's crucial to understand that AML is a blood cancer that can affect the kidneys indirectly. The primary concern is the potential for tumor lysis syndrome, a condition where the rapid breakdown of cancer cells releases harmful substances into the bloodstream, overwhelming the kidneys and potentially leading to acute kidney injury 1.
Key Mechanisms of Kidney Impact
- Tumor lysis syndrome: The rapid release of uric acid, potassium, and phosphate from broken-down cancer cells can overwhelm the kidneys' filtering capacity.
- Sepsis and hypotension: Common complications in AML patients that can further compromise kidney function.
- Nephrotoxic medications: Certain chemotherapy agents and antibiotics used in AML treatment can be harmful to the kidneys.
Monitoring and Prevention
- Regular monitoring of kidney function through blood tests (creatinine and blood urea nitrogen levels) is essential, especially during initial treatment phases.
- Preventive measures include adequate hydration, the use of allopurinol or rasburicase to manage uric acid levels, and careful dosing of medications based on kidney function to minimize additional renal stress during treatment 1. Given the potential for significant kidney impact, it is recommended that patients with AML undergo thorough assessment and monitoring of their kidney function throughout their treatment. This approach can help mitigate the risk of kidney damage and ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Definition of AML in Relation to Kidney Function
- AML (Acute Myeloid Leukemia) is a type of cancer that affects the blood and bone marrow, and it can have significant implications for kidney function 2, 3, 4, 5, 6.
- Kidney problems can occur in patients with AML due to various factors, including the disease itself, chemotherapy, and other treatments 2, 3, 4, 5, 6.
Kidney-Related Complications in AML Patients
- Acute kidney injury (AKI) is a common complication in AML patients undergoing induction chemotherapy, and it can lead to chronic impairment of kidney function 2.
- Lysozymuria, a rare paraneoplastic complication of AML, can cause severe electrolyte derangements and kidney damage 3.
- Nephrotic syndrome, a condition characterized by excessive proteinuria, can develop in AML patients after treatment with certain medications, such as macrophage-colony-stimulating factor (M-CSF) 5.
- Kidney failure can complicate the presentation of AML, but it can be rapidly reversible with treatment 6.
Risk Factors and Management
- Risk factors for kidney problems in AML patients include older age, pre-existing kidney disease, and certain medications 2, 4, 5, 6.
- Management of kidney problems in AML patients requires careful consideration of nutrition, fluid management, and the choice of medications to minimize the risk of kidney damage 2.
- Early detection and treatment of kidney problems are crucial to prevent long-term damage and improve outcomes in AML patients 2, 3, 4, 5, 6.