Kidney involvement in myelodysplastic syndromes

Marie-Camille Lafargue; Jean-Paul Duong Van Huyen; Helmut G Rennke; Marie Essig; Mickaël Bobot; Noémie Jourde-Chiche; Hamza Sakhi; Alexandre Karras; Idris Boudhabhay; Philippe Brunet; Hugoline Boulay; Vincent Grobost; Carole Philipponnet; Juliette Jeannel; Jonathan Chemouny; Jean-Jacques Boffa; Dorra Braham-Stambouli; Umut Selamet; Leonardo V Riella; Olivier Fain; Lionel Adès; Pierre Fenaux; Camille Cohen; Arsène Mekinian

doi:10.1093/ckj/sfae185

Kidney involvement in myelodysplastic syndromes

Clin Kidney J. 2024 Jun 19;17(8):sfae185. doi: 10.1093/ckj/sfae185. eCollection 2024 Aug.

Authors

Marie-Camille Lafargue¹, Jean-Paul Duong Van Huyen², Helmut G Rennke³, Marie Essig⁴, Mickaël Bobot⁵, Noémie Jourde-Chiche⁵, Hamza Sakhi⁶, Alexandre Karras⁷, Idris Boudhabhay⁶, Philippe Brunet⁵, Hugoline Boulay⁸, Vincent Grobost⁹, Carole Philipponnet¹⁰, Juliette Jeannel¹¹, Jonathan Chemouny¹², Jean-Jacques Boffa¹³, Dorra Braham-Stambouli¹⁴, Umut Selamet¹⁵, Leonardo V Riella¹⁶, Olivier Fain¹⁷, Lionel Adès¹⁸, Pierre Fenaux¹⁸, Camille Cohen¹⁹, Arsène Mekinian¹⁷

Affiliations

¹ Department of Nephrology, Tenon's Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
² Department of Pathology, Université Paris Cité, Necker's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
³ Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, Université Paris-Saclay, Paris, France.
⁵ Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, CHU de la Conception, Marseille, France.
⁶ Department of Nephrology, Necker's Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
⁷ Department of Nephrology, CHU HEGP, Paris, France.
⁸ University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France.
⁹ CHU Estaing, Médecine interne, Clermont-Ferrand, France.
¹⁰ Nephrology, Dialysis and Transplantation Department, University Hospital, Clermont-Ferrand, France.
¹¹ Internal Medicine Department, Strasbourg University Hospital, Strasbourg, France.
¹² Transplant Unit, Department of Nephrology, University Hospital, Rennes, France.
¹³ Department of Nephrology, Sorbonne University, Tenon's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁴ Department of Hematology, University Hospital, Rennes, France.
¹⁵ Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹⁶ Center for Transplantation Sciences, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹⁷ Sorbonne Université, Hôpital Saint-Antoine, Service de Médecine Interne et de l'Inflammation-(DHU i2B), Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁸ Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
¹⁹ Service de Néphrologie Hémodialyse, Hôpital Bichat - Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.

Abstract

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.

Keywords: ANCA-associated vasculitis; acute kidney injury; auto-immunity; myelodysplastic syndromes; myeloid neoplasms.