Renal Disease in Hematological Malignancies

Hematological malignancies can affect the kidneys in different ways. There may be direct invasion by the tumor cells, or the malignancy may act indirectly via immunologically mediated mechanisms. Primary renal lymphoma (PRL) without evidence of extrarenal spread has also been reported. The existence of this entity, however, has been questioned, because the kidneys do not normally contain lymphoid tissue. Renal involvement is rare in leukemias, and in some leukemias, renal dysfunction is usually found during the blastic crisis. Renal infiltration of leukemic cells has been recognized in some patients. In addition, some types of hematological neoplasia are associated with severe hypercalcemia that can lead to nephrocalcinosis. Renal involvement is one of the major manifestations of multiple myeloma (MM) and is an important cause of renal failure in the elderly. Renal failure occurs in more than 50% of MM patients, and is usually caused by the so-called myeloma kidney. Tumor lysis syndrome (TLS) is an oncological emergency characterized by a combination of metabolic disorders observed at the start of treatment of hematological malignancies. TLS may also be associated with the advancement of aggressive lymphomas and leukemias. The syndrome is frequently associated with renal dysfunction. Bone marrow transplantation for treatment of selected hematological neoplasms can be complicated by renal failure resulting from a variety of causes. Early renal injury most often results from infection and its subsequent treatment. Late renal injury after bone marrow transplantation, characterized by a syndrome similar to the hemolytic uremic syndrome, is called bone marrow transplant (BMT) nephropathy. This article reviews the clinical and pathological features of renal injury in hematological malignancies.