Unusual Manifestation Of Acute Leukemia With Hematuria – A Case Report

Abstract

An 11-year-old boy with a family history of IgA nephropathy presented with hematuria, edema, hypertension, and oliguria. He had no hepatosplenomegaly or lymphadenopathy. Blood investigations revealed leukocytosis with normal renal function and urinalysis revealed gross hematuria. Because of the hematuria, he was suspected to have post-streptococcal glomerulonephritis, with potential diagnoses of IgA nephropathy and renal parenchymal disease. Additionally, lymphoproliferative disease involving the kidneys needed to be investigated due to leukocytosis. A full blood count revealed 49% of blast cells. Bone marrow studies confirmed B-cell acute lymphoblastic leukemia. Renal biopsy only demonstrated minor glomerular changes with acute tubular injury changes and granular cast. There were no features of leukemic infiltration. Immunofluorescence studies and electron microscopy findings showed no evidence of immune-mediated glomerulonephritis. After the commencement of chemotherapy, his leukemia achieved remission with hematuria resolution. His hypertension was controlled with antihypertensive drugs. This case report highlights a rare renal manifestation as the initial presentation of leukemia