Pediatric Nephrology

, Volume 23, Issue 5, pp 835–839 | Cite as

Simultaneous occurrence of atypical hemolytic uremic syndrome and acute lymphoblastic leukemia: a case report and literature review

  • Rajiv SinhaEmail author
  • Abdullah AlAbbas
  • Janis M. Dionne
  • Robert Morrison Hurley
Brief Report


A 3.5-year-old girl with fever had a pancytopenic blood smear that also showed schistocytes and blast cells. Bone marrow examination resulted in a diagnosis of acute lymphoblastic leukemia (ALL). Although creatinine on admission was normal, she had mild hematuria and moderate proteinuria. Chemotherapy was started, but she was initially given only steroids (dexamethasone) due to high liver enzymes. Her renal parameters worsened, and her creatinine doubled. She also developed nephrotic-range proteinuria and hypertension. Renal biopsy showed thrombotic microangiopathy that was clinically consistent with hemolytic uremic syndrome (HUS). Some reports of HUS preceding ALL do exist. However, to the best of our knowledge, this is the first case that describes ALL and HUS presenting simultaneously.


Atypical hemolytic uremic syndrome Acute lymphoblastic leukemia 



We sincerely acknowledge the contribution of Dr. Alex Magill (Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver) for his help with the biopsy slides, Wendy Cannon (Scholarly Activities Coordinator UBC Department of Pediatrics) for her valuable suggestions, and Dr. Christoph Licht, M.D., (pediatric nephrologist, The Hospital for Sick Children, Toronto, Canada) for his help in analyzing factor H and factor I levels.


  1. 1.
    Gordon LI, Kwaan HC (1997) Cancer- and drug-associated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Semin Hematol 34:140–147PubMedGoogle Scholar
  2. 2.
    Kavanagh D, Goodship TH, Richards A (2006) Atypical haemolytic uraemic syndrome. Br Med Bull 77–78:5–22PubMedCrossRefGoogle Scholar
  3. 3.
    Salcedo JR, Fusner J (1986) Hemolytic uremic syndrome followed by acute lymphocytic leukaemia. Int J Pediatr Nephrol 7:169–172PubMedGoogle Scholar
  4. 4.
    Martini G, Dall’Amico R, Murer L, Montini G, D’Avino A, Zacchello G (2000) Hemolytic uremic syndrome as a presenting form of acute lymphocytic leukaemia. Ann Hematol 79:452–454PubMedCrossRefGoogle Scholar
  5. 5.
    Hahn H, Ha IS, Choi HS, Shin HY, Cheong HI, Ahn HS, Choi Y (2003) Acute leukemia: an association with atypical hemolytic uremic syndrome. Pediatr Nephrol 18:703–705PubMedGoogle Scholar
  6. 6.
    Lowe EJ, Werner EJ (2005) Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome in children and adolescents. Semin Thromb Hemost 31:717–730PubMedCrossRefGoogle Scholar
  7. 7.
    Moschcowitz E (1924) Hyaline thrombosis of the terminal arterioles and capillaries: a hitherto undescribed disease. Proc NY Pathol Soc 24:21–24Google Scholar
  8. 8.
    Veyradier A, Obert B, Haddad E, Cloarec S, Nivet H, Foulard M, Lesure F, Delattre P, Lakhdari M, Meyer D, Girma JP, Loirat C (2003) Severe deficiency of the specific von Willebrand factor-cleaving protease (ADAMTS 13) activity in a subgroup of children with atypical hemolytic uremic syndrome. J Pediatr 142:310–317PubMedCrossRefGoogle Scholar
  9. 9.
    Gasser C, Gautier E, Steck A, Siebenmann R, Oechslin R (1955) Hemolytic-uremic syndrome: bilateral necrosis of the renal cortex in acute acquired hemolytic anemia. Schweiz Med Wochenschr 85:905–909PubMedGoogle Scholar
  10. 10.
    Kanchi H, Webb NJ, Eden OB (2000) Hemolytic uremic syndrome secondary to the treatment of acute lymphoblastic leukemia. J Pediatr Hematol Oncol 22:483–484PubMedCrossRefGoogle Scholar
  11. 11.
    Chandra D, Lawson S, Ramani P (2004) Atypical haemolytic uraemic syndrome as a complication of induction chemotherapy for acute lymphoblastic leukaemia. J Clin Pathol 57:667–669PubMedCrossRefGoogle Scholar
  12. 12.
    Cavagnaro F, Barriga F (2000) Hemolytic uremic syndrome in a child with leukemia and cytomegalovirus infection. Pediatr Nephrol 14:1118–1120PubMedCrossRefGoogle Scholar
  13. 13.
    Candoni A, Pizzolitto S, Boscutti G, Fanin R (2005) Atypical haemolytic-uraemic syndrome at the onset of acute promyelocytic leukaemia. Br J Haematol 128:274PubMedCrossRefGoogle Scholar
  14. 14.
    Lòpez EL, Contrini MM, De Rosa S (1994) Tumor necrosis factor (TNF-a) levels in hemolytic uremic syndrome (HUS) patients and children with bloody diarrhea (BD) in Argentina. In: Karmali MA, Goglio AG (eds) Recent advances in verocytotoxin-producing Escherichia coli infection. Elsevier, Bergamo, pp 373–376Google Scholar
  15. 15.
    Blot E, Decaudin D, Veyradier A, Bardier A, Zagame OL, Pouillart P (2002) Cancer-related thrombotic microangiopathy secondary to Von Willebrand factor-cleaving protease deficiency. Thromb Res 106:127–130PubMedCrossRefGoogle Scholar
  16. 16.
    Grossi IM, Hatfield JS, Fitzgerald LA, Newcombe M, Taylor JD, Honn KV (1988) Role of tumor cell glycoproteins immunologically related to glycoproteins Ib and IIb/IIIa in tumor cell-platelet and tumor cell-matrix interactions. FASEB J 2:2385–2395PubMedGoogle Scholar

Copyright information

© IPNA 2007

Authors and Affiliations

  • Rajiv Sinha
    • 1
    Email author
  • Abdullah AlAbbas
    • 2
  • Janis M. Dionne
    • 1
  • Robert Morrison Hurley
    • 1
  1. 1.Department of Pediatrics, Division of NephrologyBritish Columbia’s Children’s HospitalVancouverCanada
  2. 2.PediatricsBritish Columbia’s Children’s HospitalVancouverCanada

Personalised recommendations