AML with Renal Infiltration Manifesting as Acute Renal Failure, Diagnosed with FDG-PET CT Scan: Case Report

Case Report

Ann Hematol Oncol. 2021; 8(10): 1368.

AML with Renal Infiltration Manifesting as Acute Renal Failure, Diagnosed with FDG-PET CT Scan: Case Report

Chauhan P¹, Gupta A¹, Ora M², Agrawal S¹ and Nityanand S¹*

1Department of Haematology, SGPGIMS, Lucknow (UP), India

2Department of Nuclear Medicine, SGPGIMS, Lucknow (UP), India

*Corresponding author: Soniya Nityanand, Department of Haematology, I block, SGPGIMS, Raebareli Road, 226014, Lucknow, India

Received: June 21, 2021; Accepted: July 15, 2021; Published: July 22, 2021


Extramedullary disease in acute myeloid leukemia is a known phenomenon with reported incidence of 2.5-9.1 %. However, acute kidney injury due to direct infiltration of malignant cells is reported in only 1% cases of acute leukemia. We report a case of acute myeloid leukemia who developed acute kidney failure at presentation, was diagnosed with renal and pancreatic infiltration by FDG-PET scan and was treated successfully with hypomethylating agent and venetoclax. PET-CT scan can be a non-invasive modality for diagnosing extramedullary disease in acute myeloid leukemia and monitoring of response to therapy in these cases. Early initiation of anti-leukemia therapy in our case lead to complete metabolic response with normalization of the renal functions.

Keywords: Acute kidney injury; Acute myeloid leukemia; FDG-PET CT scan


AML: Acute Myeloid Leukaemia; AKI: Acute Kidney Injury; PETCT: Positron Emission Tomography and Computed Tomography; HMA: Hypomethylating Agent; GMI: Galactomannan Index; CECT: Contrast Enhanced Computed Tomography; TLS: Tumour Lysis Syndrome

Case Presentation

Acute Kidney Injury (AKI) is the most common renal complication in haematological malignancies [1-5]. Different mechanisms leading to acute kidney injury in haematological malignancies includes tumour lysis syndrome, hypoperfusion, acute tubular necrosis and direct renal infiltration [6]. Acute renal failure arising from direct renal infiltration of malignant cells has been reported in only 1% cases acute leukaemia [7,8]. We report a case of Acute Myeloid Leukaemia (AML) with waxing and waning course of AKI diagnosed with the help of FDG PET-CT scan and managed successfully with Hypomethylating Agent (HMA) + Venetoclax based therapy.

50-year-old male patient with history of type 2 diabetes mellitus for 6 years, hypertension for 5 years and anxiety disorder for 1 year, presented to our hospital with complaints of fever and generalized weakness for 20 days. Patient required 4 units of blood transfusions during this period. No history of rashes over body, yellowish discolouration of eyes, cough, bleeding from any site, decreased urine output, swelling over any area of body or facial puffiness.

Examination was unremarkable except for moderate pallor. Baseline investigations are enlisted in Table 1.