Renal impairment in hematological malignancies

Background: Hematological malignancies are among the most frequent non-renal cancers associated with kidney involvement. Renal manifestations range from mild functional abnormalities to overt renal failure and are influenced by disease type, duration, comorbidities, and exposure to nephrotoxic therapies. Aim: To determine the frequency of renal impairment and identify its associated clinical and treatment-related factors among patients with hematological malignancies. Patients and Methods: This prospective study included 96 patients with hematological malignancies who were evaluated for suspected renal involvement. Demographic data, duration of malignancy, and comorbidities particularly diabetes mellitus and hypertension were recorded. Laboratory investigations included blood urea, serum creatinine, serum electrolytes, and albumin-to-creatinine ratio (ACR). Based on ACR values, patients were classified into two groups: with renal impairment and without renal impairment. Patterns of antimicrobial use and type of malignancy were also analyzed. Results: Renal impairment was detected in 31 patients (32.29%), while 65 patients had normal ACR. Patients with renal impairment had a significantly longer disease duration (9.55±3.29 vs. 7.80±3.72 years). Diabetes mellitus was markedly more frequent in the renal impairment group (70.97% vs. 9.23%). Use of nephrotoxic agents was also higher, particularly vancomycin (74.19% vs. 52.31%) and amphotericin B (51.61% vs. 29.23%). Multiple myeloma was the malignancy most strongly associated with renal impairment. These patients exhibited significantly higher serum calcium and lower potassium and albumin levels compared with patients with leukemia or lymphoma. Conclusion: Renal impairment affects nearly one-third of patients with hematological malignancies. Longer disease duration, diabetes mellitus, and exposure to nephrotoxic drugs are key risk factors. Multiple myeloma carries the highest renal risk, commonly accompanied by hypercalcemia and electrolyte disturbances.