leukemia kidney damage
Introduction
Introduction to leukemia and kidney damage Leukemia is a malignant proliferative disease of white blood cells that infiltrates and destroys other system tissues and organs when cancer cells enter the bloodstream. Leukemia can cause kidney damage (leukemianephropathy). The kidney is the third easily infiltrating organ of acute leukemia. It is mainly caused by direct infiltration or metabolites of leukemia cells, causing kidney damage. It can also damage the kidney through immune reaction and electrolyte disorder. Acute renal failure, chronic renal insufficiency, nephritic syndrome or nephrotic syndrome. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific people Mode of infection: non-infectious Complications: uremia, chronic renal failure, urinary calculi, acute renal failure
Cause
Causes of leukemia and kidney damage
Cause:
The occurrence of renal damage in leukemia cells may be related to hematopoietic tissue in the embryonic kidney. Kidney infiltration is the most common cause of acute leukemia. Acute mononuclear leukemia and acute lymphoblastic leukemia are more likely to infiltrate the kidney. Leukemia cells often infiltrate the kidney directly. It can infiltrate the renal parenchyma, renal interstitial, renal blood vessels, perirenal tissue and urinary tract.
Pathogenesis
1. Leukemia cells infiltrating leukemia cells often infiltrate the kidney directly, which can infiltrate the renal parenchyma, renal interstitial, renal blood vessels, perirenal tissue and urinary tract. The incidence of renal infiltration may be related to the hematopoietic tissue of the embryonic kidney. Acute Kidney infiltration is the most common cause of leukemia, and acute monocytic leukemia and acute lymphoblastic leukemia are more likely to infiltrate the kidney.
2. Immune response Chronic lymphocytic leukemia can be complicated by immune complex nephritis. Under the electron microscope, fibrillar submicrostructure can be found. This fibrillar sediment is an immune complex composed of IgG and anti-IgG antibody. In addition, the cell Immune pathogenesis is also possible.
3. Metabolic abnormalities Leukemia cell nuclear protein metabolism accelerates, blood uric acid production increases, the highest acute lymphoblastic leukemia, followed by acute granulocyte type and acute monocytic leukemia, 30% of patients with chronic leukemia with uric acid nephropathy, blood uric acid The increase is often 8932975mol/L. The degree of uric acid increase is related to the metabolism and destruction rate of tumor cells. Acute leukemia is characterized by acute uric acid nephropathy. Chronic leukemia, especially chronic myeloid leukemia, causes urinary stones and blood uric acid. The increase is not as obvious as acute leukemia. In chemical medicine treatment, especially strong chemotherapy, tumor cells disintegrate rapidly, and uric acid production increases greatly. When dehydration or urine pH is too acidic, uric acid is more likely to deposit in renal tissue and urinary tract. Urinary calculi or acute uric acid nephropathy, and even cause acute renal failure.
4. Electrolyte disorders and other hypercalcemias account for 2.5%, mostly acute lymphoblastic leukemia patients, followed by stem cell type and chronic lymphocytic leukemia, which is caused by leukemia cell infiltration causing bone destruction, releasing excessive calcium into Blood, persistent long-term high blood calcium can lead to hypercalcemic nephropathy, hypokalemia can occur during the course of leukemia, and can also cause damage to the renal tubules.
Monocyte-type and granulocyte-monocytic leukemia can produce a large amount of lysozyme, which can damage the proximal tubule, which is characterized by hypokalemia, acidosis, renal glucosuria, etc., which is commonly used in the treatment of methotrexate. The urinary metabolite 7-hydroxymethoxazole has a water solubility four times lower than that of methotrexate, forming a yellow precipitate in an acidic environment, and even forming large crystals, which deposit in the renal tubules, causing tubular dilatation. And damage, resulting in urinary tract obstruction and renal insufficiency.
Prevention
Leukemia and kidney damage prevention
The prevention of this disease is divided into three levels of prevention as other malignant tumors.
Primary prevention is the prevention of cancer. The goal is to prevent the occurrence of cancer. Its tasks include studying the causes and risk factors of various cancers, and taking preventive measures against specific cancer, cancer-promoting factors and pathogenic conditions in vitro and in vivo, such as chemical, physical and biological. And for the healthy body, take environmental protection, suitable diet, suitable for sports, to promote physical and mental health.
The goal of secondary prevention or preclinical prevention is to prevent the development of initial disease, including early detection of cancer, early diagnosis, early treatment, to prevent or slow the progression of the disease, and reverse to phase 0 as soon as possible.
Tertiary prevention is clinical (periodical) prevention or rehabilitative prevention. Its goal is to prevent the deterioration of the disease and the occurrence of disability. The task is to adopt multidisciplinary diagnosis (MDD) and treatment (MDT), and choose the right and best treatment plan to fight cancer as soon as possible. Try to promote recovery and rehabilitation, prolong life, improve the quality of life, and even reintegrate into society.
Complication
Leukemia and kidney damage complications Complications uremia chronic renal failure urinary calculi acute renal failure
Common complications include urinary calculi, uremia, and acute and chronic renal failure.
Symptom
Leukemia and kidney damage symptoms Common symptoms Urinary calculi Chronic renal insufficiency Urinary occlusion Hypertension Proteinuria Collapse Leukemia Cell infiltration Multi-urine
The clinical manifestations of leukemia causing kidney damage are:
1. Obstructive nephropathy: Obstructive nephropathy is the main manifestation of renal damage caused by leukemia, mostly caused by urate crystals or stones, a small number of cases caused by methotrexate treatment, uric acid nephropathy often unilateral low back pain, sometimes performance For renal colic, urinary microscopy has red blood cells, sometimes gross hematuria, a large amount of urate crystals can be detected in the urine, sometimes uric acid stones are discharged, and acute renal failure is often oliguria or anuria.
According to different uric acid deposition sites, obstructive nephropathy is divided into renal obstruction and extrarenal obstructive uric acid nephropathy. Renal obstructive nephropathy is mainly caused by acute leukemia, especially lymphoblastic leukemia. Blood uric acid is significantly increased, and uric acid is rapidly deposited. Renal tubules, causing acute renal obstructive uric acid nephropathy, showing acute oliguria or urinary closed acute renal failure, while chronic leukemia, blood uric acid slightly increased slowly, uric acid gradually deposited in the urinary tract, forming stones and causing extrarenal obstruction Long-term extrarenal obstructive nephropathy can occur, and the above two types can coexist at the same time.
2. Nephritis syndrome: leukemia cells infiltrate the renal parenchyma or cause hematuria, proteinuria, hypertension, etc. through immune response, and may even be a manifestation of acute nephritic syndrome, causing oliguria or no urine and renal function in a short period of time. Depletion.
3. Nephrotic syndrome: Some patients have glomerular damage due to immune dysfunction, a large amount of proteinuria (greater than 3.5g/24h), low plasma albumin (less than 30g/L), high blood lipids and edema.
4. Renal tubule-interstitial lesions: clinical manifestations of polyuria, diabetes, alkaline urine, severe acute renal failure, occasionally renal diabetes insipidus, which occurs because leukemia cells infiltrate the renal tubules and Quality, electrolyte imbalance, a large amount of lysozyme production, or chemotherapy drugs.
5. Uremia With the progress of chemotherapy drugs, the survival time of leukemia patients is significantly prolonged, and the complications of leukemia increase, especially the kidney involvement, chronic renal insufficiency, increased serum creatinine, decreased creatinine clearance, acidosis, The kidneys shrink until uremia.
In view of the fact that the kidney damage of leukemia has no obvious clinical manifestations, it must be closely observed in the diagnosis and treatment of leukemia. Once there is urinary abnormality, high blood pressure, pain or mass in the kidney area, further examination should be carried out to confirm the diagnosis. Before leukemia chemotherapy and treatment Check blood uric acid, uric acid, urine volume, urine routine and renal function, etc., should pay attention to early detection of uric acid nephropathy, by doing kidney B-mode ultrasound and X-ray examination to find extra-resectal obstruction and urinary calculi.
Examine
Examination of leukemia and kidney damage
1. Blood test: In addition to the clinical laboratory test results of leukemia, renal albumin may have low plasma albumin (less than 30g / L), elevated blood lipids, increased serum creatinine, decreased creatinine clearance, blood uric acid higher than 773.24mol /L (13mg%) or more, acidosis until uremia and other changes.
2. Urine examination: There are a lot of red blood cells (sometimes gross hematuria) in uroscopy, and a large amount of urate crystals can be detected in urine. (Sometimes there may be uric acid stones.) In addition to hematuria, proteinuria can be seen. A large number of proteinuria (greater than 3.5g / 24h), diabetes, alkaline urine, severe renal failure, and occasional renal diabetes insipidus.
3. Bone marrow examination: It has the significance of specific diagnosis. In the early stage of the disease, bone marrow changes can help diagnose leukemia.
4. X-ray examination: Common uric acid deposits in the stones formed by the urinary tract, and there is extrarenal obstruction.
5. B-ultrasound: Kidney B-mode ultrasound examination, can be found in extra-renal obstruction and urinary calculi and kidney morphology changes.
6. Pathological examination: The weight of the kidney is significantly increased, mainly related to leukemia cell infiltration, hemorrhage, and other non-specific changes in the kidney. The renal tubules are calcinous, sometimes the glomerulus is also calcium, and the leukemia cells are mainly infiltrated. The pathological changes of the affected kidney can be divided into two types: diffuse invasive type and nodular type.
(1) diffuse infiltration type: the kidney is swollen, the color becomes white, and the texture of the medullary line on the cut surface is unclear. Under the microscope, the leukemia cells infiltrated by the nephron are divided into intervals, which are seen in acute, chronic leukemia and kidney damage.
(2) Nodular type: nodules ranging in size from a few millimeters to several centimeters, usually distributed in the cortex, more common in acute leukemia, leukemia cells infiltrating the kidney, acute lymphocytic leukemia is the most serious, monocytic leukemia The granulocyte-type leukemia is the lightest.
Clinical manifestations of nephrotic syndrome, glomerular pathology may be minimal pathological nephropathy, may also be membranous nephropathy and mesangial capillary disease, in some patients with renal tubular, renal pelvis, renal pelvis have urate crystal deposition Even uric acid stones are formed, and histological changes of obstructive nephropathy such as tubular dilatation and damage are found. The renal interstitial is pathological changes of interstitial nephritis, but most of them are microscopic lesions.
In hyperuricemia, urate deposition and late renal interstitial fibrosis can be seen in the renal interstitial-renal tubule.
Diagnosis
Diagnosis and diagnosis of leukemia and renal damage
Diagnostic criteria
Diagnosis of leukemia complicated with uric acid nephropathy by meeting the following criteria:
1. Leukemia patients with acute renal failure and no other reasons can be investigated.
2. Have a microscopic examination of hematuria or gross hematuria.
3. Uric acid crystals are found in the urine.
4. Blood uric acid is higher than 773.24mol/L (13mg%) or more.
It is distinguished from obstructive nephropathy such as hyperuricemia and urinary tract stones caused by other causes.
