title: Hematuria and decreased kidney function as initial signs of acute B-cell lymphoblastic leukemia.
abstract: We report the case of a 14-year-old boy who presented with hematuria and decreased kidney function as initial manifestations of acute lymphoblastic leukemia (ALL). Computed tomography of the abdomen showed extensive retroperitoneal lymphadenopathy and bilateral nephromegaly. The patient's kidney biopsy specimen showed a dense monomorphous interstitial infiltrate of small round blue cells with significant nuclear atypia. Immunohistochemical workup showed positive staining for CD20, CD10, and terminal deoxynucleotidyl transferase (TdT), consistent with ALL. The patient underwent induction chemotherapy, attained remission 4 weeks after induction, and presently is stable in the consolidation phase of chemotherapy. This is an unusual case of ALL involving both kidneys with initial presenting signs of hematuria and decreased kidney function.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520-8023, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Seo-Mayer
authors.forename: Barton
authors.initials: B
authors.lastname: Kenney
authors.forename: Joseph
authors.initials: J
authors.lastname: McNamara
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Stein
authors.forename: Gilbert W
authors.initials: GW
authors.lastname: Moeckel
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001706:Biopsy; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology