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Updated: Jun 18, 2025
Use of Hematopoietic Stem Cell Transplantation to Assess the Origin of Myelodysplastic Syndrome
Published on: October 3, 2018
Kidney involvement in myelodysplastic syndromes
Marie-Camille Lafargue1, Jean-Paul Duong Van Huyen2, Helmut G Rennke3
1Department of Nephrology, Tenon's Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
Introduction:
The objective of this study was to describe kidney involvement in patients with myelodysplastic syndromes (MDS), their treatments, and outcomes.
Methods:
We conducted a multicenter retrospective study in seven centers, identifying MDS patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities.
Results:
Fifteen patients developed a kidney disease 3 months after MDS diagnosis. Median urine protein-to-creatinine ratio was 1.9 g/g, and median serum creatinine was 3.2 mg/dL. Ten patients had AKI at presentation, and 12 had extra-renal symptoms. The renal diagnoses included anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), ANCA negative vasculitis, C3 glomerulonephritis, immune complex-mediated glomerulonephritis, polyarteritis nodosa, and IgA vasculitis. All patients but one received a specific treatment for the MDS-associated kidney injury. The effect of MDS treatment on kidney injury could be assessed in six patients treated with azacitidine, and renal function evolution was heterogenous. After a median follow-up of 14 months, four patients had CKD stage 3, five had CKD stage 4, and three had end stage kidney disease. On the other hand, three evolved to an acute myeloid leukemia and three died. Compared to 84 MDS controls, patients who had kidney involvement were younger, had a higher number of dysplasia lineages, and were more eligible to receive hypomethylating agents, but no survival difference was seen between the two groups. Compared to 265 AAV without MDS, the ten with MDS-associated pauci-immune vasculitis were older, ANCA serology was more frequently negative, and more cutaneous lesions were seen.
Conclusion:
The spectrum of kidney injuries associated with MDS is mostly represented by vasculitis with glomerular involvement, and especially AAV.
Insights
Kidney disease, primarily vasculitis, frequently affects myelodysplastic syndromes (MDS) patients. Treatments vary, with mixed renal outcomes and no survival impact compared to MDS alone.
Area of Science:
- Nephrology
- Hematology
- Internal Medicine
Background:
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
- Kidney involvement in MDS is not well-characterized.
- Understanding renal manifestations is crucial for patient management.
Purpose of the Study:
- To describe kidney involvement in patients with myelodysplastic syndromes (MDS).
- To analyze treatments and outcomes of renal disease in MDS patients.
- To compare characteristics of MDS patients with kidney involvement to controls.
Main Methods:
- Multicenter retrospective study involving seven centers.
- Identification of MDS patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities.
- Comparison with MDS controls and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients without MDS.
Main Results:
- Fifteen MDS patients developed kidney disease, predominantly vasculitis (including ANCA-associated vasculitis).
- Common findings included high proteinuria, elevated creatinine, and extra-renal symptoms.
- Outcomes varied, with progression to CKD, end-stage kidney disease, or transformation to acute myeloid leukemia.
Conclusions:
- Kidney injuries in MDS are primarily vasculitis with glomerular involvement, notably ANCA-associated vasculitis.
- Specific treatments were administered, but renal function evolution was heterogeneous.
- MDS patients with kidney involvement showed distinct characteristics but similar survival to MDS controls.
