From the Guidelines
Yes, Chronic Myelomonocytic Leukemia (CMML) can cause renal failure through several mechanisms. CMML is a hematologic malignancy that causes abnormal proliferation of monocytes and can infiltrate various organs, including the kidneys. Renal failure in CMML patients may occur due to direct leukemic infiltration of the kidneys, which disrupts normal kidney structure and function. Additionally, CMML can cause hyperviscosity syndrome from high white blood cell counts, leading to impaired blood flow to the kidneys. Tumor lysis syndrome may develop during treatment, releasing cellular contents that overwhelm the kidneys. CMML patients often experience thrombotic microangiopathy, where small blood vessels in the kidneys become damaged.
Key Mechanisms of Renal Failure in CMML
- Direct leukemic infiltration of the kidneys
- Hyperviscosity syndrome
- Tumor lysis syndrome
- Thrombotic microangiopathy
Monitoring and Treatment
Patients with CMML should have regular kidney function monitoring through blood tests measuring creatinine and BUN levels, and urinalysis to detect proteinuria or hematuria. Treatment of CMML-related kidney dysfunction focuses on addressing the underlying disease with hypomethylating agents like azacitidine or decitabine, while maintaining adequate hydration and avoiding nephrotoxic medications when possible 1.
Recent Guidelines and Recommendations
Recent studies and guidelines, such as those from the European LeukemiaNet 1 and the NCCN Clinical Practice Guidelines in Oncology 1, emphasize the importance of managing CMML with a focus on preventing and treating complications, including renal failure. The use of hypomethylating agents and other targeted therapies has shown promise in improving outcomes for CMML patients, including those with renal involvement 1.
Conclusion Not Applicable - Direct Answer Only
The most recent and highest quality study, 1, supports the use of hypomethylating agents in the treatment of CMML, including for patients with renal involvement.
From the Research
CMML and Renal Failure
- Chronic Myelomonocytic Leukemia (CMML) is a hematologic disorder that can be associated with autoimmune and inflammatory diseases, including renal complications 2.
- Studies have shown that CMML can cause renal failure, with kidney involvement being a common feature of the disease 2, 3.
- The renal complications of CMML can be direct or indirect, including prerenal azotemia, glomerular disease, tubulointerstitial involvement, and renovascular disorders 3.
Mechanisms of Renal Failure in CMML
- Lysozyme nephropathy and renal infiltration by CMML cells are two of the most frequent renal complications of CMML 2.
- Hyperuricemia and uric acid nephropathy can also contribute to renal failure in CMML patients 4.
- Renal dysfunction in CMML can be attributed to various factors, including hyperlysozymemia, leukemic infiltration, and secondary diseases 5.
Clinical Presentations and Outcomes
- CMML patients with renal involvement may present with acute kidney injury, chronic kidney disease, or end-stage kidney disease 2, 4.
- The prognosis of CMML patients with renal involvement is generally poor, with a high risk of progression to acute myeloid leukemia (AML) and mortality 2, 4.
- Treatment of CMML-related renal complications may involve hematologic therapies, such as hydroxyurea or hypomethylating agents, as well as supportive care for renal failure 2, 6.