Acute Lymphatic Leukemia Masquerading as Recurrent Acute Kidney Injury – A Case Report

Acute kidney injury (AKI) is an uncommon presenting feature in acute lymphatic leukemia (ALL). We report an unusual case of a 15-year-old girl who has experienced multiple episodes of AKI over an 8 month period with unremarkable WBC counts. She now returned with constitutional symptoms and rapidly progressive renal failure with bulky kidneys, proteinuria, and sterile pyuria. A renal biopsy revealed diffuse interstitial infiltration with CD3 positive, TdT positive, and CD20 negative lymphoblasts, suggestive of acute T cell leukemia. Bone marrow studies and flow cytometry later confirmed the diagnosis of T cell ALL. Unfortunately, she succumbed to an intracranial bleed during the intensive phase of chemotherapy. In addition to the atypical presentation of ALL, this case highlights the importance of timely renal biopsy in cases of AKI, where the cause is unclear.