We want tо present a rare clinical case challenging in diagnosing the cause of acute kidney injury in a child with acute lymphoblastic leukemia (ALL)

Borysova, T

Samsonenko, S

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neutrophil to lymphocyte ratio, higher levels of ferritin, CRP and d-Dimer were found to be statistically significant factors in developmentof AKI. Mortality was found to be significantly higher in patients withAKI (12%) compared to patients without AKI (0.8%).Conclusions: AKI is common among patients hospitalised with COVID-19 and is associated with high mortality. Neutrophil to lymphocyteratio, serum ferritin, CRP and d-Dimer are early markers to predict thedevelopment of AKI and assess the severity of infection, hence guide tobetter and appropriate measures in the treatment.No conflict of interestPOS-207THREE CASE REPORTS OF RENAL INFARCTION:SIMILAR CLINICAL PRESENTATION, DIFFERENTETIOLOGIESSABAH, M*1, Khalfaoui, MA2, Chehab, N2, El oury, H2, Jabrane, F2,Medkouri, G21Mohamed VI University of Health Sciences UM6SS, Nephrology, casa-blanca, Morocco, 2Mohammed VI University of Health Sciences UM6SS,Nephrology, Casablanca, MoroccoIntroduction: Renal infarction is a rare under-reported condition and israrely diagnosed at presentation. As it can mimic other conditions, suchas nephrolithiasis and pyelonephritis, the diagnosis is often delayed ormissed. Unfortunately, this leads to late treatment initiation andtherefore may result in irreversible kidney damage. The most commoncauses are thromboembolism and atheromatous disease. We presentthree case reports of renal infarction with similar clinical presentationbut with distinctive etiologies and evolution.Methods: The first patient is a 62 years old female patient with a knownhistory of myeloproliferative syndrome presenting at the emergencydepartment with severe respiratory distress and left acute low-back pain.CT angiography revealed pulmonary embolism. An abdominal CT wasperformed revealing a hypodense peripheral triangle-shaped area in theleft kidney. Cytobacteriological testing of urine was normal. The patientreceived anticoagulation and was discharged two weeks later with nokidney damage. The second case is a 40 years old male patient with aknown history of a mutation in COL3A1 gene associated with vascularEhlers–Danlos syndrome, who presented with acute right flank pain andfever. Urinalysis was normal. White blood cell count was elevated at 15000 cells per cubic millimeter. Urinalysis showed 20 white blood cells perfield. Abdominal computed tomography showed a triangular hypodensearea in the right kidney, initially interpreted as pyelonephritis. The pa-tient received antibiotics without clinical improvement. CT angiogramwas then pursued and revealed asymmetric contrast enhancement of theright kidney. Antibiotic therapy was withheld and the patient receivedheparin with symptom resolution after three days of anticoagulationResults: The third case is a 51 years old female who presented withacute abdominal pain and acute kidney injury following mitral valverepair. Acute kidney injury was considered as a complication of cardiacsurgery. Urine analysis was positive for hematuria. Doppler sonogra-phy of the kidney showed multiple triangle-shaped hypoechogenicareas in both kidneys with reduced arterial flow. The patient sufferedirreversible renal damage with the need for renal replacement therapy.Conclusions: In summary, renal infarction is an easily underdiagnosedpathology due to its nonspecific presentation. It should always beconsidered a differential diagnosis in acute flank pain, especially whenthe urinalysis is negative for infection. Early diagnosis is the key torapid recovery.No conflict of interestPOS-208CAUSE OF ACUTE KIDNEY INJURY ANDUNILATERAL KIDNEY ENLARGEMENT IN ACHILD WITH ACUTE LYMPHOBLASTICLEUKEMIA: A CASE REPORTBorysova, T1, SAMSONENKO, S*11SI " Dnepropetrovsk Medical Academy Ministry of Health of Ukraine",Pediatrics, Dnipro, UkraineIntroduction: We want tp present a rare clinical case challenging indiagnosing the cause of acute kidney injury in a child with acutelymphoblastic leukemia (ALL).Methods: General clinical examination, ultrasound, computed tomog-raphy (CT), morphological study of the kidneys.Results: A child, 5 years old, was admitted in severe general condition,with subfebrile temperature, skin hemorrhagic syndrome of petechialand macular type, the enlargement of neck and occipital lymph nodes,and hepatosplenomegaly. Total blood count: Hb 95 g/L; RBC 3,24y1012/L;WBC 30,6y109/L; PLT 58y109/L; neutrophile 6,9%; lymphocyte 88%;monocyte 5,1%. Bonemarrow evaluation: acute lymphoblastic leukemia,FAB type L1, ALL-type common. Therapy according to the protocol ALLIC-BFM-2002 was started. After one week febrile fever and abdominalpain manifested. Urinalysis: WBCs 5-10. Ultrasound has detected theenlargement of the left kidney (110y51 mm), increased echogenicity ofthe parenchyma with hypoechogenic sectors; dilatation of the renalpelvis. Acute pyelonephritis was suspected. Antibacterial therapy wasadministered. The child’s condition didn’t improve - febrile fever,decreased diuresis, increased serum creatinine (1,27 mg/dl). Acute kid-ney injury was diagnosed, stage «Injury». CT: the left kidney enlarged(106y67y56 mm), the structure is heterogeneous; no visualization of theleft pyelocaliceal system, parenchyma of the left kidney does not accu-mulate the contrast, the left renal vein does not contrast; right kidney isnot changed. Thrombosis of the left renal artery andveinwere diagnosed.A left-sided nephrectomy was performed. Light microscopy of the kid-ney: ischemic necrosis with diffuse spread of leukemic infiltrates, fusinghemorrhages; in the paranephric body - diffuse capillary thrombosis,lymphoblastic infiltrates and hemorrhages.Conclusions: The clinical case demonstrates challenges in identifyingthe causes of acute kidney injury in a child with ALL and unilateralnephromegaly. The acute kidney injury was explained by renal causes -the thrombosis of the renal artery and vein, leukemic infiltration of thekidney parenchyma.No conflict of interestPOS-209IMMUNE CHECKPOINTS INHIBITORS-ASSOCIATED ACUTE KIDNEY INJURY: ASINGLE-CENTRE STUDYSEYLANOVA, N*1, Cennamo, A2, Flanders, L3, Shaunak, N3,Papa, S3, Ostermann, M4, Lumlertgul, N41Guy's and St Thomas' NHS Foundation Trust, Department of Critical Care,London, United Kingdom, 2Guy's and St Thomas' NHS Foundation Trust,Department of Nephrology, London, United Kingdom, 3Guy's and StThomas' NHS Foundation Trust, Department of Medical Oncology, London,United Kingdom, 4Guy's and St Thomas' NHS Foundation Trust, Depart-ment of Critical Care, London, United KingdomIntroduction: Immune checkpoints inhibitors (ICPi) have transformedthe treatment and prognosis in patients with various malignancies.Having specific immune mechanism of action, these drugs can causeimmune-related adverse events, including acute kidney injury (AKI).Our aim was to investigate the incidence, management, and outcomes ofpatients with ICPi-associated AKI.Methods: The data of all patients receiving either avelumab, durvalu-mab, pembrolizumab, nivolumab, ipilimumab or atezolizumab betweenDecember 2011 and November 2020 were collected retrospectively usingelectronic patient records. ICPi-associated AKI (ICPi-AKI) was identifiedas: 1) an increase in serum creatinine (SCr) of 50% plus either tubu-lointerstitial nephritis on kidney biopsy, withholding ICPi, or steroidsgiven due to AKI; 2) a doubling of SCr from baseline or requiring renalreplacement therapy (RRT). ICPi-AKI had to be attributed by the treatingphysician and occur within 180 days after the last dose of ICPi.Results: One thousand one hundred and seventy patients wereincluded; 190 (14.7%) patients had AKI, with 28 (2.4%) having ICPi-AKI. Of those with ICPi-AKI, 14 had underlying CKD and 20.7% weretreated with proton-pump inhibitors prior to AKI onset. Eight andtwenty patients had AKI stage 1 and 2, respectively. The median timefrom first ICPi dose to AKI onset was 104.5 (IQR 60-198) days, and themedian time from the last ICPi dose to AKI onset was 20 (IQR 17-34)days. Urinalysis was performed in four (14%) patients which showedproteinuria in 100%, haematuria in 75%, and leukocyturia in 25%. Themedian eosinophil percentage was 2.9 (IQR 2-4). Renal ultrasound andbiopsy were performed in 18 (64%) and 3 (11%) patients, all of whichrevealed tubulointerstitial nephritis. Sixteen patients (58%) had extra-renal immune-related adverse events (irAE) at any time, with 7 patientsexperiencing other irAE concomitantly with AKI. Thirteen (46%) pa-tients were hospitalised, and one patient required RRT.In the majorityof patients (26, 93%), immunotherapy was held due to ICPi-AKI onset.93% of patients received steroids at a median of 3 days (IQR 0-9) afterthe AKI onset. The initial median prednisolone-equivalent dose was 40(IQR 31-64) mg/day. The median time to steroid tapering to 10ISN WCN 2021, MONTREAL, CANADAKidney International Reports (2021) 6, S1–S362 S87

Cause of acute kidney injury and unilateral kidney enlargement in a child with acute lymphoblastic leukemia: a case report

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Cause of acute kidney injury and unilateral kidney enlargement in a child with acute lymphoblastic leukemia: a case report

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Cause of acute kidney injury and unilateral kidney enlargement in a child with acute lymphoblastic leukemia: a case report

Abstract

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Repository for DZ &quot;DMA&quot;

Repository for DZ "DMA"