For years, most people with myeloproliferative neoplasms (MPNs) and their doctors have focused on risks like blood clots, enlarged spleen, and progression to myelofibrosis or leukemia. But a growing body of research suggests another important concern has been hiding in plain sight: kidney damage.
In some studies, up to 80% of MPN patients have signs of chronic kidney disease (CKD), and worse kidney function was linked with more blood clots, higher blood pressure, and more inflammation. This raises an important question: why would a blood cancer and kidney problems be so closely connected?
How MPNs Might Affect the Kidneys
Normally, the kidneys act as the body’s natural filters, clearing waste and helping control blood pressure. Inside each kidney are tiny filters called glomeruli—delicate tangles of very small blood vessels. If these vessels are damaged, kidney function can slowly decline, often without obvious symptoms at first.
Researchers from the University of North Carolina in Chapel Hill are testing a new idea about what might be going wrong in MPNs:
- In MPNs, certain white blood cells (neutrophils) appear to wrongly display a clot‑triggering protein called tissue factor on their surface.
- Tissue factor acts like “super glue” for the clotting system. When it shows up in the wrong place—in the bloodstream instead of hidden in damaged tissues—it may cause very small clots in tiny vessels, including those in the kidneys.
- Over time, these microscopic clots may quietly injure the glomeruli, creating tiny holes and scars that slowly weaken the kidneys’ filtering ability.
In experimental models, kidney specialists working have seen unusual damage patterns in MPN‑related kidneys that they have not observed in other diseases, supporting the idea that MPNs may cause a distinct type of kidney injury.
One major concern is that the usual blood tests for kidney function, like serum creatinine, are not very sensitive to early changes. By the time creatinine levels rise, as much as half of kidney function may already be lost.
What This Could Mean for Future MPN Care
This line of research is still ongoing, but it could have several important implications for patients:
- Better monitoring: Kidney function may become a more routine focus in MPN visits, including urine tests and more sensitive blood measurements.
- New clinical trial endpoints: Kidney health could serve as a “readout” for how well treatments are protecting the body, allowing researchers to see benefits earlier instead of waiting years for events like blood clots or major organ damage.
- New treatment strategies: Therapies that reduce inflammation or clotting may eventually be studied not only for their impact on classic MPN symptoms and events, but also for their ability to protect the kidneys.
Researchers are now collecting blood and urine samples from MPN patients over time to better understand how kidney function changes and to identify early warning signs that might be used in future trials and clinical practice.
What Patients Can Do Now
If you live with an MPN, you may want to:
- Ask your doctor whether your kidney function has been checked recently.
- Discuss whether urine testing for protein or other markers is appropriate for you.
- Make sure your care team knows about any changes in blood pressure, swelling in the legs or ankles, or changes in urination.
While more research is needed, one message is already clear: kidney health deserves a place alongside blood counts, clotting risk, and symptom control when it comes to understanding and managing MPNs.
References
Christensen, A. S., Møller, J. B., & Hasselbalch, H. C. (2014). Chronic kidney disease in patients with the Philadelphia-negative chronic myeloproliferative neoplasms. Leukemia Research, 38(4), 490–495. https://doi.org/10.1016/j.leukres.2014.01.014
Gecht, J., Tsoukakis, I., Kricheldorf, K., Stegelmann, F., Klausmann, M., Griesshammer, M., Schulz, H., Hollburg, W., Göthert, J. R., Sockel, K., Heidel, F. H., Gattermann, N., Maintz, C., Al-Ali, H. K., Platzbecker, U., Hansen, R., Hänel, M., Parmentier, S., Bommer, M., … Koschmieder, S. (2021). Kidney Dysfunction Is Associated with Thrombosis and Disease Severity in Myeloproliferative Neoplasms: Implications from the German Study Group for MPN Bioregistry. Cancers, 13(16), Article 16. https://doi.org/10.3390/cancers13164086
Kalejaiye, T. D., Holmes, J. A., Bhattacharya, R., & Musah, S. (2022). Chapter 24—Reconstitution of the kidney glomerular capillary wall. In M. S. Goligorsky (Ed.), Regenerative Nephrology (Second Edition) (pp. 331–351). Academic Press. https://doi.org/10.1016/B978-0-12-823318-4.00007-X
