Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient

Kultigin Turkmen¹, Lutfullah Altintepe², Ibrahim Guney², Ismet Aydogdu³, Osman Koc⁴, Mehmet Ali Erkut⁵, Halil Zeki Tonbul¹

¹Department of Nephrology, Meram School of Medicine, Selcuk University, ²Meram Training and Research Hospital, Selcuk University, ³Department of Hematology, Meram School of Medicine, Selcuk University, ⁴Department of Radiology, Meram School of Medicine, Selcuk University, ⁵Department of Hematology, Meram Training and Research Hospital, Selcuk University

Abstract: Leukemic infiltration of the kidney is usually silent, and the admission of the patients with renal dysfunction or acute kidney injury is uncommon. We present a 34-year old hemodialysis patient with new onset of uncontrolled hypertension, erythropoietin-resistant anemia, thrombocytopenia, and Bell’s palsy. On admission, his blood pressure (BP) was 210/110 mmHg and he had petechiae and purpura at upper and lower extremities. Renal ultrasonography (USG) showed bilaterally enlarged kidneys without hydronephrosis, unlike his previous USG, which determined bilaterally atrophic kidneys. Acute lymphoblastic leukemia, hypertensive crisis due to bilateral leukemic cell infiltration of kidneys, tumor lysis syndrome, and leukemic involvement of the facial nerve were diagnosed. Despite intense antihypertensive management, his BP was not controlled. After prednisolone, daunorubicine, and vincristine therapy, the size of kidneys diminished and his BP dropped under normal range. In conclusion, pathological findings such as uncontrolled hypertension, flank pain, skin rashes, and abnormal blood count should be considered carefully, even in patients with end-stage renal disease receiving renal replacement therapy.

Keywords: leukemic cell infiltration, uncontrolled hypertension, hemodialysis