Kidney Involvement in Patients With Chronic Myelomonocytic Leukemia or BCR-ABL-Negative Myeloproliferative Neoplasms

Julie Belliere; Magali Colombat; Clément Kounde; Christian Recher; David Ribes; Antoine Huart; Dominique Chauveau; Véronique Demas; Isabelle Luquet; Odile Beyne-Rauzy; Suzanne Tavitian; Stanislas Faguer

doi:10.1016/j.ekir.2020.12.005

Kidney Involvement in Patients With Chronic Myelomonocytic Leukemia or BCR-ABL-Negative Myeloproliferative Neoplasms

Kidney Int Rep. 2020 Dec 14;6(3):737-745. doi: 10.1016/j.ekir.2020.12.005. eCollection 2021 Mar.

Authors

Julie Belliere^{1

2

3}, Magali Colombat^{3

4}, Clément Kounde¹, Christian Recher^{3

5}, David Ribes¹, Antoine Huart¹, Dominique Chauveau^{1

2

3}, Véronique Demas^{3

6}, Isabelle Luquet⁶, Odile Beyne-Rauzy^{3

7}, Suzanne Tavitian⁵, Stanislas Faguer^{1

2

3}

Affiliations

¹ Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'Organes, Centre de reference des Maladies rénales rares, Toulouse, France.
² INSERM U1048, Institut des maladies métaboliques et cardio-vasculaires, Toulouse, France.
³ Université Paul Sabatier, Toulouse, France.
⁴ Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Département d'Anatomopathologie, Toulouse, France.
⁵ Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Service d'Hématologie, Toulouse, France.
⁶ Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Laboratoire d'Hématologie, Toulouse, France.
⁷ Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Service de Médecine interne, Toulouse, France.

Abstract

Introduction: The identification of specific molecular signatures and the development of new targeted drugs have changed the paradigm of onco-nephrology, now allowing a multiscale approach of kidney involvement related to hematologic malignancies relying on combined hematologic and molecular assessments. In this study, we aimed to refine the spectrum of kidney disorders associated with chronic myelomonocytic leukemia (CMML) or BCR-ABL-negative myeloproliferative neoplasms (MPNs), 2 very rare conditions scarcely described.

Methods: Case series. Patients with myeloid neoplasms who were referred to Toulouse University Hospital Nephrology Unit and were diagnosed with acute kidney injury (AKI), chronic kidney disease (CKD), or urine abnormalities were retrospectively included.

Results: Eighteen patients (males n=13, CMML n=8, essential thrombocytosis [ET] n=7, polycythemia vera [PV] n=1, and myelofibrosis n=2) developed kidney disease 7.7±2 years after the diagnosis of the malignancy. Twelve patients had AKI at presentation. Eight patients had glomerular presentation (high-range proteinuria 33%, microscopic hematuria 56%). Kidney biopsy (n=14) showed various patterns, including pauci-immune glomerulosclerosis (n=5), extramedullary hematopoiesis (n=6), or tubular atrophy and interstitial fibrosis with polymorphic inflammation (n=8). Immunostaining of CD61 confirmed the infiltration of megakaryocytes within glomeruli or interstitium in 5 of 8 patients. Other pictures of glomerulopathy were identified in 3 patients (IgA nephropathy n=2, AA amyloidosis n=1). Massive kidney infiltration by CMML was identified in 1 patient. After a mean follow-up of 24±6 months, malignancy was considered as stable in 11 patients (61%), but 22% of patients had progressed to end-stage renal failure. The remaining had persistently reduced kidney function. No correlation between the malignancy and the renal presentation and outcomes could be identified.

Conclusions: Kidney complications of CMML/MPN are heterogenous, and kidney biopsy may help to identify new molecular targets to prevent the development of kidney fibrosis.

Keywords: chronic kidney disease; chronic myelomonocytic leukemia; essential thrombocytosis; megakaryocytes; myeloid neoplasms; myeloproliferative neoplasms.