[Renal changes in acute leukemia in children at onset. Incidence and prognostic value]. / Alterazioni renali nella leucemia acuta del bambino all'esordio. Incidenza e valore prognostico.

Microscopic leukemia infiltration of kidneys is a common autoptic finding in children for ALL before starting specific treatment. However, a palpable renal enlargement is uncommon. The authors have performed an intravenous pyelogram (IVP) in 139 pediatric cases of acute leukemia, 117 of whom ALL, the remaining 22 ANLL. ALL patients were divided in 3 groups; Group 1 was made of 18 children treated with IGG-74 protocol, independently by any prognostic factor; Group 2 included 46 patients presenting one or more negative factors; Group 3 was of 53 cases with no unfavourable factor. Abnormal IVP was found in 4/18 (22,2%) Group 1, 9/46 (19,5%) Group 2, 2/53 (3,8%) Group 3 ALL patients. The most common anomaly was a bilateral renal enlargement with normal or slightly compromised renal function. Only 3 out of 117 ALL children had palpable renal masses. All 15 children acquired CR within one month from starting therapy together with normalization of IVP. Six out of 15 of these cases died, one is alive with disease, 8 are alive in CR. Except for two cases, all presented other negative prognostic factor associated with abnormal IVP. One of 22 ANLL children had an abnormal IVP: only one kidney was involved with the unique mechanism of intraparenchimal hemorrhage and hydronephrosis due to the filling of renal pelvis and ureter by multiple coarse cloths. In conclusions, major renal alterations are present in about 10% of ALL children, rarely in ANLL. This finding is commonly associated with unfavorable prognostic factors.

[Value of ultrasonics and computerized axial tomography in the staging of renal neoplasms]. / Valore dell'ultrasonografia e della tomografia assiale computerizzata nella stadiazione delle neoplasie renali.

Sonographic (US) and computed tomographic (CT) images obtained in 47 patients with renal cancer have been reviewed; attention was paid to detection of neoplastic spread to structures surrounding the tumor, presence of lymph node metastases and of thrombosis of renal vessels and to identification of distant metastases. The results of the revision process were then compared with surgical or autoptic findings. In a relatively high number of patients, a complete examination of the upper abdomen could not be performed by US, due to patient habitus or bowel gas; on the contrary, a diagnostic study could be obtained by CT in virtually all cases. Furthermore, differentiation of stage I and stage II lesions could never be obtained by US; only CT gave this possibility. As regards the sensitivity of the two methods, in patients with stage III or stage IV disease, US showed relatively lower sensitivity in the diagnosis of lymph node metastases, but it was significantly less sensitive in the study of distant metastases. On the contrary, the specificity of the two imaging methods was similar, and US gave better results in the evaluation of renal vein or inferior vena cava thrombosis.