Acute Myeloid Leukemia and Your Kidneys: What You Need to Know

Acute myeloid leukemia (AML) is a cancer that affects the bone marrow, where blood cells are made. While the disease primarily affects blood cell production, it can also indirectly impact other organs, including the kidneys. This impact can stem from the disease itself or from the therapies used to treat it.

How AML and Its Treatments Can Affect Your Kidneys

AML's Direct Impact

In some cases, AML can directly affect the kidneys. This can occur in around 30% of patients with AML when leukemia cells infiltrate the kidneys, hindering their ability to filter waste products from the blood. While this is less common than treatment-related kidney issues, it's a possibility, especially in patients with a high white blood cell count at diagnosis. One study found that a high white blood cell count significantly increased the risk of kidney complications in AML patients.

Treatment-Related Impact

Chemotherapy drugs, a cornerstone of AML treatment, can sometimes damage the kidneys. These powerful medications are designed to kill cancer cells but can also harm healthy cells in the process. The kidneys, responsible for filtering medications from the bloodstream, are particularly vulnerable. 

In addition to chemotherapy, other AML treatments like bone marrow transplantation can also pose risks to kidney health. Medications used to prevent complications after transplantation, such as immunosuppressants, antibiotics, or antifungals, can also potentially impact kidney function.

Immunotherapies, like immune checkpoint inhibitors and CAR T-cell therapy, can also potentially lead to kidney inflammation and damage, though this is less common than with chemotherapy.

It's important to note that not everyone with AML will experience kidney problems. However, understanding the potential risks is crucial for early detection and management.

Recognizing the Signs of Kidney Impairment

Kidney problems often develop gradually, with symptoms appearing only when significant damage occurs. Being aware of these symptoms is vital:

• Fatigue: Feeling unusually tired and lacking energy.
• Swelling: Noticeable swelling in the legs, ankles, feet, face, or hands due to fluid retention.
• Changes in urination: Increased or decreased urine output, foamy urine, or difficulty urinating.
• Shortness of breath: Difficulty breathing, especially when lying down, due to fluid buildup in the lungs.
• Nausea and vomiting: Feeling sick to your stomach and experiencing vomiting.

You must contact your healthcare team if you experience any of these symptoms. Early detection and treatment of kidney problems are crucial for preventing further complications.

Understanding Kidney Complications

When discussing kidney problems, you might come across various medical terms that sound complicated. To help clarify, let's break down a few common terms you might encounter in your healthcare journey:

• Kidney impairment: A general term indicating reduced kidney function. This can range from mild to severe.
• Kidney failure: A severe condition where the kidneys can no longer effectively filter waste from the blood. This can be acute (sudden onset) or chronic (long-term).
  • Acute Kidney Injury (AKI): A sudden and often reversible decline in kidney function. AKI is a serious condition that requires prompt medical attention.
  • Chronic Kidney Disease (CKD): A long-term condition characterized by a gradual and irreversible decline in kidney function over time.

Managing Kidney Problems in AML Patients

Treatment for kidney complications in AML patients depends on the underlying cause and severity. Options may include:

• Adjusting medications: If a medication is suspected to be causing kidney problems, your doctor may adjust the dosage or switch to a different drug.
• Intravenous fluids: In cases of dehydration or volume depletion, intravenous fluids may be administered to support kidney function.
• Medications to control blood pressure and potassium levels: Medications may be prescribed to manage high blood pressure and elevated potassium levels, which can further strain the kidneys.
• Dialysis: In severe cases of kidney failure, dialysis may be necessary to filter waste products from the blood.

Treating kidney problems in AML patients can be complex, as decisions must consider both the kidney condition and the underlying cancer. Close collaboration between your oncology team and a kidney specialist (nephrologist) is essential for developing an individualized treatment plan.

Impact of Kidney Injury on AML Treatment and Survival

Kidney problems can significantly impact the course of AML treatment and overall survival. Studies have shown that patients with pre-existing kidney impairment or those who develop kidney injury during treatment may have:

• Lower response to chemotherapy: Kidney problems can affect the body's ability to process and eliminate chemotherapy drugs, potentially reducing their effectiveness.
• Increased risk of treatment complications: Patients with kidney issues may be more susceptible to infections and other complications from chemotherapy or bone marrow transplantation.
• Poorer overall survival: Several studies have linked kidney problems in AML patients to a less favorable prognosis and decreased survival rates. However, other factors like AML subtype or percentage of blasts have a more significant weight than kidney function.

It's crucial to remember that every patient is different, and the impact of kidney problems can vary widely. Close monitoring of kidney function, early intervention, and careful management of both AML and kidney health are essential for improving outcomes.

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Sources:

• The impact of kidney function on survival in elderly patients diagnosed with acute myeloid leukemia
• Renal complications in acute leukemias
• Acute kidney injury adversely affects the clinical course of acute myeloid leukemia patients undergoing induction chemotherapy
• Risk for Significant Kidney Function Decline After Acute Kidney Injury in Adults With Hematologic Malignancy
• Predictors and outcome of acute kidney injury in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome
• Kidney Involvement in Leukemia and Lymphoma
• Immunotherapies and renal injury