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A rare cause of acute kidney injury with chronic myelomonocytic leukemia

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Abstract

An 80-year-old man with myelodysplastic syndrome developed acute kidney injury (AKI) and peripheral blood monocyte-dominant leukocytosis. Glomerular disease was suspected from urinalysis, which showed proteinuria and microscopic hematuria with red cell casts. Eventually, he died of respiratory failure, after which a postmortem was performed. In the glomeruli, the extracapillary space was filled with numerous mononuclear cells and erythrocytes. At first interpretation, the glomerular findings appeared to represent cellular crescents. However, immunostaining revealed that the extracapillary mononuclear cells were in fact leukemic cells. Furthermore, tubular injury due to marked accumulation of lysozyme was also recognized together with infiltration of leukemic cells in the interstitium. The diagnosis of kidney infiltration by chronic myelomonocytic leukemia (CMML) and lysozyme-induced tubular injury was eventually made. Our case is the first report showing extracapillary infiltration of leukemic cells by immunostaining. In addition, lysozyme-induced tubular injury is a forgotten cause of kidney injury in patients with CMML. This case teaches us the rare and forgotten causes of AKI with CMML.

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Authors and Affiliations

  1. Department of Nephrology and Renal Replacement, Daido Hospital, 9, Hakusui-cho, Minami-ku, Nagoya, 457-8511, Japan

    Marina Asano, Hanako Hase, Yuki Naruse, Kyogo Kawada & Hideaki Shimizu

  2. Department of Pathology, Daido Hospital, Nagoya, Japan

    Iori Kojima

  3. Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura City, Japan

    Joel Branch

  4. Department of Pathology, National Hospital Organization Chiba Higashi National Hospital, Chiba, Japan

    Hiroshi Kitamura

Authors
  1. Marina Asano
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  2. Hanako Hase
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  3. Yuki Naruse
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  4. Kyogo Kawada
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  5. Iori Kojima
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  6. Joel Branch
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  7. Hiroshi Kitamura
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  8. Hideaki Shimizu
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Correspondence to Marina Asano.

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Asano, M., Hase, H., Naruse, Y. et al. A rare cause of acute kidney injury with chronic myelomonocytic leukemia. CEN Case Rep 10, 320–325 (2021). https://doi.org/10.1007/s13730-020-00567-6

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  • DOI: https://doi.org/10.1007/s13730-020-00567-6

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