Munker R, Hill U, Jehn U, Kolb H J, Schalhorn A
Medizinische Klinik III, Ludwigs-Maximilians-Universität München (Klinikum Grosshadern), Germany.
Haematologica. 1998 May;83(5):416-21.
Renal failure is a known complication of acute leukemias both at diagnosis and following cytostatic treatment. No recent studies give data on the incidence and risk factors of renal complications and their prognostic impact.
Two hundred and twenty consecutive adult patients with newly diagnosed acute leukemia treated at a major university medical center were evaluated for renal complications before, during, and after treatment; 166 patients were treated by chemotherapy only and 54 patients were treated with chemotherapy and later transplanted with allogeneic or autologous bone marrow. Renal complications were subdivided into 3 entities: acute renal failure, major and minor complications, based on clinical and laboratory parameters. Renal failure occurring as a consequence of terminal multi-organ failure was excluded from the present study.
Approximately 30% of patients in the chemotherapy group had a renal complication either before or after chemotherapy. Patients undergoing transplantation had a 50% risk of renal complications. Risk factors for complications were male sex, age, previous kidney disease, white cell count, and refractory leukemia (chemotherapy group) and allogeneic versus autologous transplant (transplant group). In the chemotherapy group, early but not delayed renal complications had a poor prognostic impact. In the transplant group renal complications had no impact on prognosis. In all patient groups, acute renal failure was prognostically unfavorable.
We conclude from our study that renal complications are frequent in acute leukemias and that the treatment and prevention of renal complications is important for the management of acute leukemias.
肾衰竭是急性白血病在诊断时以及进行细胞毒性治疗后的一种已知并发症。近期没有研究提供关于肾脏并发症的发生率、危险因素及其预后影响的数据。
对一所主要大学医学中心连续收治的220例新诊断的成年急性白血病患者在治疗前、治疗期间和治疗后进行肾脏并发症评估；166例患者仅接受化疗，54例患者接受化疗，随后进行异体或自体骨髓移植。根据临床和实验室参数，将肾脏并发症分为3类：急性肾衰竭、主要和次要并发症。本研究排除因终末期多器官衰竭导致的肾衰竭。
化疗组约30%的患者在化疗前或化疗后出现肾脏并发症。接受移植的患者发生肾脏并发症的风险为50%。并发症的危险因素包括男性、年龄、既往肾脏疾病、白细胞计数、难治性白血病（化疗组）以及异体移植与自体移植（移植组）。在化疗组中，早期而非延迟出现的肾脏并发症对预后有不良影响。在移植组中，肾脏并发症对预后无影响。在所有患者组中，急性肾衰竭在预后方面都不利。
我们从研究中得出结论，肾脏并发症在急性白血病中很常见，并且肾脏并发症的治疗和预防对急性白血病的管理很重要。
