Renal Impairment in Myeloproliferative Neoplasms: An Under-reported Complication

Renal involvement in myeloproliferative disorders (MPNs) is rare and presents unique challenges in terms of diagnosis and treatment. The exact pathogenesis of renal dysfunction in MPNs remains unclear. Most of these patients are elderly and have comorbid conditions that contribute to their renal dysfunction. Although symptomatic patients typically present with proteinuria, hypertension, anasarca, and hematuria, many patients remain asymptomatic with incidental detection of renal impairment. Early diagnosis using renal biopsy and prompt initiation of treatment with corticosteroids, cytoreductive drugs, and targeted agents are crucial for achieving a favorable outcome. We present a series of case vignettes describing our approach and management strategies in a spectrum of MPN patients (primary myelofibrosis, essential thrombocytosis, chronic myeloid leukemia, and pre-fibrotic myelofibrosis) with biopsy proven etiologies of renal dysfunction. Although extramedullary hematopoiesis was a common finding in all our cases, we discuss the various other mechanisms by which MPN can target the kidneys. Despite the widespread use of cytoreductive and targeted therapies, such situations require an individualized approach along with multidisciplinary effort.