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Diffuse large B cell lymphoma presenting with renal failure and bone lesions in a 46-year-old woman: a case report and review of literature. CEN Case Rep 2020; 10:165-171. [PMID: 32989684 DOI: 10.1007/s13730-020-00537-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022] Open
Abstract
Renal involvement in large B-cell lymphoma represents an exceptional manifestation of non-Hodgkin lymphomas. Renal failure and bone metastasis by lymphomatous infiltration is extremely rare. We describe a 46-year-old woman presenting with a renal failure and a 5-month history of intermittent left knee pain that was previously misdiagnosed with osteoarthritis. It was due to a bilateral primary renal lymphoma (PRL) associated with bone metastasis. Knee MRI showed a permeative lesion and an abnormal signal in the metaphysis and diaphysis of the left proximal tibia with periosteal reaction and surrounding soft tissue swelling. The CT body scan showed a bilateral nephromegaly and multiple lytic bone lesion of aggressive appearance at the right iliac wing and right sacral ala evoking lymphomatous involvement. Node biopsy with immunohistochemistry study confirmed a diagnosis of large B-cell lymphoblastic lymphoma. In this article, we focus on clinical, radiological, immunohistochemical presentation, differential diagnosis and review the literature. Ten cases including our case were reported in our literature review of both renal and bone lymphoma. There was a male predominance, with a mean age of 55.1 years old. We noted a high frequency of renal failure in diagnosis. In X-rays, the metaphysis is the most common site of occurrence in long bones and the main sign was osteolytic bone destruction. The subtype of lymphoma was DLBCL stage IV in most cases except in one case where it was a hystiocytic lymphoma. Finally, prognosis was poor, more than half of patients died. PRL with bone metastasis is a rare malignancy that is difficult to diagnose. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Early diagnosis and active treatment can improve patient prognosis.
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Sherief LM, Azab SF, Zakaria MM, Kamal M, Elbasset Aly MA, Ali A, Alhady MA. Renal Presentation in Pediatric Acute Leukemia: Report of 2 Cases. Medicine (Baltimore) 2015; 94:e1461. [PMID: 26376384 PMCID: PMC4635798 DOI: 10.1097/md.0000000000001461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Renal enlargement at time of diagnosis of acute leukemia is very unusual. We here in report 2 pediatric cases of acute leukemia who had their renal affection as the first presenting symptom with no evidences of blast cells in blood smear and none of classical presentation of acute leukemia. The first case is a 4-year-old girl who presented with pallor and abdominal enlargement. Magnetic resonance imaging showed bilateral symmetrical homogenous enlarged kidneys suggestive of infiltration. Complete blood picture (CBC) revealed white blood count 11 × 10⁹/L, hemoglobin 8.7 g/dL and platelet count 197 × 10⁹/L. Bone marrow aspiration was performed, and diagnosed precursor B-cell ALL was made. The child had an excellent response to modified CCG 1991 standard risk protocol of chemotherapy with sustained remission, but unfortunately relapsed 11 month after the end of therapy. The second child was 13-month old, presented with pallor, vomiting, abdominal enlargement, and oliguria 2 days before admission. Initial CBC showed bicytopenia, elevated blood urea, creatinine, and serum uric acid, while abdominal ultrasonography revealed bilateral renal enlargement. Bone marrow examination was done and showed 92% blast of biphenotypic nature. So, biphynotypic leukemia with bilateral renal enlargement and acute renal failure was subsequently diagnosed. The patients admitted to ICU and received supportive care and prednisolone. Renal function normalized and chemotherapy was started. The child achieved complete remission with marked reduction of kidney size but, unfortunately she died from sepsis in consolidation phase of therapy. This case demonstrates an unusual early renal enlargement in childhood acute leukemia. Renal involvement of acute leukemia should be considered in child presenting with unexplained bilateral renal enlargement with or without renal function abnormalities and bone marrow examination should be included in the workup.
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Affiliation(s)
- Laila M Sherief
- From the Department of Pediatrics, Faculty of Medicine, Zagazig and Cairo Universities, Zagazig, Egypt
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3
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Bach AG, Behrmann C, Holzhausen HJ, Katzer M, Arnold D, Spielmann RP, Surov A. Prevalence and patterns of renal involvement in imaging of malignant lymphoproliferative diseases. Acta Radiol 2012; 53:343-8. [PMID: 22287149 DOI: 10.1258/ar.2011.110523] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Renal involvement in patients with lymphoproliferative disease is an uncommon radiological finding. PURPOSE To determine its prevalence and radiological appearances in a patient population. MATERIAL AND METHODS All forms of lymphoproliferative disease (ICD: C81-C96) were considered. From January 2005 to January 2010, 668 consecutive patients with lymphoproliferative disease were identified with the help of the radiological database and patient records. Inclusion criteria were complete staging including appropriate CT scan and/or MRI. All stored images (initial staging and follow-up examinations) were reviewed. RESULTS Review of all stored images revealed renal infiltration in patients with non-Hodgkin lymphoma (11 of 364 = 3.0%; median age = 65 years, m:f = 6:5) but also multiple myeloma (2 of 162 = 1.2%; median age = 72 years; m:f = 1:1) and leukemia (5 of 101 = 4.9%; median age = 12 years; m:f = 2:3). There were no cases of renal infiltration in 41 patients with Hodgkin's disease. In total there were six patients with solitary lesions, five patients with diffuse renal enlargement, four patients with perirenal lesions, and two patients with direct invasion of the kidney. CONCLUSION In leukemia the most common imaging pattern is diffuse enlargement. In the other subtypes of lymphoproliferative disease no specific correlation between typical CT patterns and subtype of lymphoproliferative disease can be found. The prevalence of renal involvement is in line with earlier studies. Contrary to earlier reports, multiple lesions were not found to be a common pattern.
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Affiliation(s)
| | | | | | - Michaela Katzer
- Department of Urology, Martin-Luther-University Halle-Wittenberg, Halle
| | - Dirk Arnold
- University Cancer Center Hamburg, Hamburg, Germany
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4
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Kayataş M, Yıldız G, Timuçin M, Candan F, Yıldız E, Sencan M. A case of acute renal failure caused by Hodgkin's lymphoma: concurrent membranous glomerulonephritis and interstitial HL-CD 20 lymphoid infiltration. Ren Fail 2011; 33:363-6. [PMID: 21401364 DOI: 10.3109/0886022x.2011.560986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although acute renal failure developing due to malignancies is a frequent condition, malignant renal infiltration is rarely observed among these causes. Among all malignant diseases, the hematolymphoid malignancies are the most prone to renal infiltration. Other types involved in cases with lymphoma are glomerulopathies, including immune-complex glomerular diseases such as minimal change disease, membranous glomerulonephritis, membranoproliferative glomerulonephritis, and focal segmental glomerulosclerosis. We present herein the rare case of a 22-year-old male with both membranous glomerulonephritis and CD20 (+) lymphoid infiltration related to Hodgkin's lymphoma in the renal interstitial tissue, as detected on biopsy. The patient was treated with adriamycin, bleomycin, vinblastine, and dacarbazine protocol after pulse corticosteroid treatment, and a dramatic improvement in renal function was observed after 2 days of treatment. In this article, an exceptional renal involvement of Hodgkin's lymphoma is discussed in light of the related literature.
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Affiliation(s)
- Mansur Kayataş
- Department of Nephrology, Cumhuriyet University, Sivas, Turkey.
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5
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Cohen LJ, Rennke HG, Laubach JP, Humphreys BD. The spectrum of kidney involvement in lymphoma: a case report and review of the literature. Am J Kidney Dis 2010; 56:1191-6. [PMID: 20843590 DOI: 10.1053/j.ajkd.2010.07.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/01/2010] [Indexed: 11/11/2022]
Abstract
Kidney involvement is an under-recognized complication of both Hodgkin and non-Hodgkin lymphoma. The diversity of lymphoma-related renal manifestations makes diagnosis difficult. Although abrupt worsening of kidney function may be the first sign of malignant disease, renal effects can be subtle or even silent. The causes of renal involvement similarly are varied. We discuss a case of non-Hodgkin lymphoma and associated kidney failure from several distinct malignancy-related mechanisms and review the spectrum of lymphoma-related kidney involvement.
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Affiliation(s)
- Lisa J Cohen
- Nephrology Division, Brigham and Women's Hospital, Boston, MA, USA.
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6
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Neuhauser TS, Lancaster K, Haws R, Drehner D, Gulley ML, Lichy JH, Taubenberger JK. Rapidly Progressive T Cell Lymphoma Presenting as Acute Renal Failure: Case Report and Review of the Literature. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819709168586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Acute lymphoblastic leukemia presenting as non-oliguric renal failure and hypertension. Leuk Res 2010; 34:e150-1. [PMID: 20089303 DOI: 10.1016/j.leukres.2009.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 11/23/2022]
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8
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Doğan M, Bay A, Bora A, Açıkgöz M, Öner AF. Massively Enlarged Kidneys Due to
Leukemic Infiltration in
a Child. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2010. [DOI: 10.29333/ejgm/82835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Bilateral nephromegaly simulating wilms tumor: a rare initial manifestation of acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2008; 30:471-3. [PMID: 18525468 DOI: 10.1097/mph.0b013e318168e7b3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 7-year-old boy was referred with a provisional diagnosis of bilateral Wilms tumor. Peripheral smear revealed elevated leukocyte count with 90% blasts. Bone marrow aspiration and biopsy were hypercellular with sheets of blasts. Immunohistochemistry on paraffin sections showed a pre-B phenotype of acute lymphoblastic leukemia. Computerized tomographic scan of the abdomen showed moderate bilateral renal enlargement. Ultrasound-guided fine needle aspiration cytology of both kidneys showed blasts similar to those seen in the bone marrow. Finally, a diagnosis of pre-B acute lymphoblastic leukemia infiltrating both the kidneys was made. This case is being presented because of its rarity.
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10
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Rozalli FI, Chua SC, Green DJ. Elucidation of Acute Renal Failure Due to Recurrent Non-Hodgkin Lymphoma by F-18 FDG PET/CT. Clin Nucl Med 2008; 33:201-3. [DOI: 10.1097/rlu.0b013e318162ddc7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Jhamb R, Gupta N, Garg S, Kumar S, Gulati S, Mishra D, Beniwal P. Diffuse lymphomatous infiltration of kidney presenting as renal tubular acidosis and hypokalemic paralysis: case report. Croat Med J 2008; 48:860-3. [PMID: 18074421 DOI: 10.3325/cmj.2007.6.860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report the case of a 22-year-old woman who presented with acute onset flaccid quadriparesis. Physical examination showed mild pallor with cervical and axillary lymphadenopathy, hepatomegaly, and bilateral smooth enlarged kidneys. Neurological examination revealed lower motor neuron muscle weakness in all the four limbs with hyporeflexia and normal sensory examination. Laboratory investigations showed anemia, severe hypokalemia, and metabolic acidosis. Urinalysis showed a specific gravity of 1.010, pH of 7.0, with a positive urine anion gap. Ultrasound revealed hepatosplenomegaly with bilateral enlarged smooth kidneys. Renal biopsy was consistent with the diagnosis of non-Hodgkin lymphoma (B cell type). Metabolic acidosis, alkaline urine, and severe hypokalemia due to excessive urinary loss in our patient were suggestive of distal renal tubular acidosis. Renal involvement in lymphoma is usually subclinical and clinically overt renal disease is rare. Diffuse lymphomatous infiltration of the kidneys may cause tubular dysfunction and present with hypokalemic paralysis.
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Affiliation(s)
- Rajat Jhamb
- Maulana Azad Medical College, 110002 New Delhi, India
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12
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Lommatzsch SE, Bellizzi AM, Cathro HP, Rosner MH. Acute renal failure caused by renal infiltration by hematolymphoid malignancy. Ann Diagn Pathol 2006; 10:230-4. [PMID: 16844565 DOI: 10.1016/j.anndiagpath.2005.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Renal involvement by a malignant infiltrative process is often suspected in patients with bilaterally enlarged kidneys and concurrent malignancies. Acute renal failure (ARF) can rarely occur secondary to such an infiltrative process. We present 2 cases in which ARF is attributable to malignant hematolymphoid infiltration. The first case involves diffuse, bilateral involvement of the kidneys by non-Hodgkin's lymphoma. The patient's renal function improved dramatically after the initiation of chemotherapy, clearly linking the development of ARF to the malignant process. In the second case, infiltration of the kidneys by plasma cell leukemia resulted in dialysis dependence. To our knowledge, this represents the first reported case of ARF attributable to documented renal infiltration by plasma cell leukemia. A review of the potential causes of renal failure in hematolymphoid malignancy, focusing on the direct impact of the infiltrative process and on the spectrum of renal disease in plasma cell dyscrasia, is presented.
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Affiliation(s)
- Steven E Lommatzsch
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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13
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Olowu WA, Elusiyan JBE, Badejo SA, Adenowo OA. Acute renal failure in African children with Burkitt's lymphoma: a comparison of two treatment regimens. Pediatr Blood Cancer 2006; 46:446-53. [PMID: 16206217 DOI: 10.1002/pbc.20473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The outcome for patients presenting with acute renal failure and Burkitt lymphoma (BLARF) without dialysis is poor. This was a retrospective non-randomized comparative study designed to determine the outcome of two different treatment protocols. METHODS One group of patients (TPA) received oral allopurinol, intravenous (IV) cyclophosphamide, vincristine, methotrexate, furosemide, 8.4% sodium bicarbonate, and intrathecal (IT) methotrexate; the other (TPB) alternate day IV infusion of low dose cyclosphosphamide (125 mg/m(2) x 4 doses), IT methotrexate (Days 1 and 5) and aggressive pre-emptive anti-tumor lysis syndrome therapy including oral allopurinol and calcium lactate, IV calcium gluconate, salbutamol, insulin and infusions of furosemide, sodium bicarbonate and glucose. RESULTS Nine of 16 received TPA, 7 received TPB. Post chemotherapy anemia was more severe with TPA (P < 0.05). TPB patients received significantly more chemotherapy than those in TPA (P = 0.04). All 16 had tumor lysis syndrome (TLS). Six of nine patients with TPA died from this (three from other causes), two deaths in TPB were due to causes other than tumor lysis. Other evaluated outcome indices were similar in both groups. CONCLUSION Slow IV infusion of low dose cyclophosphamide given on alternate days in addition to pre-emptive anti-TLS measures (TPB) were associated with better outcome in BLARF patients compared to a high dose multiple chemotherapy regimen (TPA).
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Affiliation(s)
- Wasiu A Olowu
- Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
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14
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Boueva A, Bouvier R. Precursor B-cell lymphoblastic leukemia as a cause of a bilateral nephromegaly. Pediatr Nephrol 2005; 20:679-82. [PMID: 15714312 DOI: 10.1007/s00467-004-1740-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Revised: 09/30/2004] [Accepted: 10/01/2004] [Indexed: 10/25/2022]
Abstract
Nephromegaly and non-oliguric acute renal failure is an unusual manifestation of lymphoblastic infiltration of the kidneys. We report the clinical history of a female child where a precursor B-cell lymphoblastic proliferation was diagnosed at the age of 21 months by a surgical renal biopsy for an unexplained bilateral nephromegaly. Lymphoblastic infiltration should be suspected in any patient presenting with unexplained renal failure and enlarged kidneys. The importance of renal biopsy to identify the etiology of renal failure and nephromegaly is emphasized.
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Affiliation(s)
- Anelia Boueva
- Department of Pediatric Nephrology, Faculty of Medicine, 11 Ivan Geshov Boulevard, 1606 Sofia, Bulgaria.
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15
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Buyukpamukçu M, Varan A, Aydin B, Kale G, Akata D, Yalçin B, Akyuz C, Kutluk T. Renal Involvement of Non-Hodgkin’s Lymphoma and Its Prognostic Effect in Childhood. ACTA ACUST UNITED AC 2005; 100:c86-91. [PMID: 15824512 DOI: 10.1159/000085053] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Accepted: 01/29/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate renal involvement in childhood lymphoma and define its prognostic effects. PATIENTS AND METHODS One hundred and four patients with non-Hodgkin's lymphoma and renal involvement on admission to a single center between 1972 and 2003 were evaluated retrospectively. Blood urea nitrogen, serum creatinine, uric acid, electrolytes, and lactate dehydrogenase levels, as well as urinalysis, were evaluated. One or more of the following imaging methods were performed: intravenous urogram, ultrasound, computed tomography, and magnetic resonance imaging. The chi2 test was used to compare the groups. The Kaplan-Meier survival method was used to calculate survival rates, and the log-rank test was used to compare groups with respect to survival. Survival rates were also compared in two different time periods (before 1991 and after 1991). RESULTS There were 76 boys and 28 girls with a median age of 6 (0.9-16) years. The renal infiltration pattern was nodular in 62 patients (59.6%) and diffuse in 40 patients (38.5%). Two patients had tumoral masses that originated from their kidneys (1.9%). Renal involvement was bilateral in 75 patients (72.1%); the remaining 29 patients had unilateral involvement. The overall survival rate was 42.5% with a median follow-up of 64 months. The factors that had a statistically significant impact on survival were high creatinine (p = 0.00001) and blood urea nitrogen levels (p = 0.0001), the onset of tumor lysis syndrome (p = 0.01), and the need for dialysis (p = 0.009). The survival rate was higher in the time period after 1991 (p = 0.01). CONCLUSION Impaired renal function is a poor prognostic factor for non-Hodgkin's lymphoma. Renal function should therefore be monitored closely. Renal dysfunction caused by direct tumoral involvement may complicate therapy and shorten survival.
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Affiliation(s)
- Munevver Buyukpamukçu
- Department of Pediatric Oncology, Institute of Oncology, Hacettepe University, Ankara, Turkey
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16
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Da'as N, Polliack A, Cohen Y, Amir G, Darmon D, Kleinman Y, Goldfarb AW, Ben-Yehuda D. Kidney involvement and renal manifestations in non-Hodgkin's lymphoma and lymphocytic leukemia: a retrospective study in 700 patients. Eur J Haematol 2001; 67:158-64. [PMID: 11737248 DOI: 10.1034/j.1600-0609.2001.5790493.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Renal involvement as part of systemic lymphoma (LY) is quite frequent, however, primary extranodal renal non-Hodgkin's lymphoma (NHL) is extremely rare, and only about 65 cases have been reported in the world literature. In a retrospective study of renal manifestations in 700 patients with documented LY and chronic lymphocytic leukemia (CLL) seen at our hospital during 1986-95, 83 patients had signs of acute renal failure. Only five of these had proven renal infiltration, but none of them satisfied the criteria for primary renal LY. Glomerulonephritis (GN) has also rarely been reported in association with LY and CLL, and only 37 glomerular lesions in NHL and 42 in CLL have been documented, respectively. GN may precede, coexist, or follow the diagnosis of LY by several years. Of the 42 cases of CLL reported worldwide, 36 had nephrotic syndrome. Renal failure was seen in about one third. The most common glomerular lesion reported is membranoproliferative GN, followed by membranous GN. In our study, we found only five biopsy-proven cases with GN amongst the 700 patients seen. In this report we also briefly describe some rare interesting associated renal syndromes in CLL and NHL.
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Affiliation(s)
- N Da'as
- Department of Hematology, Hadassah University Hospital, Jerusalem, Israel
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18
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Larsen G, Loghman-Adham M. Acute renal failure with hyperuricemia as initial presentation of leukemia in children. J Pediatr Hematol Oncol 1996; 18:191-4. [PMID: 8846137 DOI: 10.1097/00043426-199605000-00020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE We report on two children who presented with hyperuricemia and acute renal failure (admission uric acid levels 57.4 and 59.2 mg/dl). RESULTS Both were subsequently diagnosed to have acute lymphoblastic leukemia, despite normal initial complete blood counts and peripheral smear. Neither patient had nephromegaly on renal ultrasound. CONCLUSIONS Hyperuricemia and acute renal failure, particularly if recurrent, may be an early presentation of childhood leukemia and should lead to a bone marrow aspirate/biopsy.
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Affiliation(s)
- G Larsen
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
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19
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Flombaum CD, Isaacs M, Reich L, Berman E, Warrell RP. Acute renal failure associated with the retinoic acid syndrome in acute promyelocytic leukemia. Am J Kidney Dis 1996; 27:134-7. [PMID: 8546128 DOI: 10.1016/s0272-6386(96)90041-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
All-trans-retinoic acid is an effective agent to induce remission in patients with acute promyelocytic leukemia (APL). Unlike conventional chemotherapy, this drug exerts its effect by inducing differentiation of immature leukemic cells. A distinctive clinical syndrome characterized by fever, dyspnea, effusions, weight gain, and organ failure (the "retinoic acid syndrome") can occur during treatment with this drug. Postmortem studies have shown extensive organ infiltration by leukemic cells, and the early administration of corticosteroids can result in prompt resolution of symptoms. We describe a patient with APL in whom acute renal failure developed during treatment with all-trans-retinoic acid. Transient renal enlargement during a period of leukocytosis and a beneficial response to treatment with dexamethasone suggest that renal failure in this patient was probably related to the retinoic acid syndrome.
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Affiliation(s)
- C D Flombaum
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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20
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Sharma UK, Jha V, Joshi K, Ahmed S, Sakhuja V. A case of non-Hodgkin's lymphoma presenting with polyuria and acute renal insufficiency. Ren Fail 1995; 17:165-9. [PMID: 7644767 DOI: 10.3109/08860229509026253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A case of non-Hodgkin's lymphoma presenting with polyuria, enlarged kidneys, and renal insufficiency is reported. The diagnosis was made by percutaneous needle biopsy of the kidney. Renal failure reversed and the kidneys regressed in size on exhibition of the first cycle of chemotherapy. The rarity of polyuria at presentation, the role of renal biopsy in the diagnosis, and the response of renal failure to specific chemotherapy are discussed.
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Affiliation(s)
- U K Sharma
- Department of Nephrology, Postgraduate Institute of Medical Education and Research Chandigarh, India
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21
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Spital A. Interstitial causes of renal failure. Ren Fail 1995. [DOI: 10.1007/978-94-011-0047-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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22
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Vachvanichsanong P, Maipang M, Dissaneewate P, Wongchanchailert M, Laosombat V. Severe hyperphosphatemia following acute tumor lysis syndrome. MEDICAL AND PEDIATRIC ONCOLOGY 1995; 24:63-6. [PMID: 7968798 DOI: 10.1002/mpo.2950240115] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report on a 14-year-old boy with acute lymphoblastic leukemia (lymphoma-leukemia) who had two episodes of acute tumor lysis syndrome during induction of remission with oral prednisolone alone and oral prednisolone, intravenous vincristine, and doxorubicin, respectively. Subsequently he had severe hyperphosphatemia (29.3 and 14.1 mg/dl; 9.46 and 4.55 mmol/L), hypocalcemia, hyperuricemia, hyperkalemia, and azotemia. Multiple stones and tumor cells infiltration were demonstrated in both kidney. He responded favorably to hemodialysis.
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Affiliation(s)
- P Vachvanichsanong
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Thailand
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23
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Eisenberg PJ, Papanicolaou N, Lee MJ, Yoder IC. Diagnostic imaging in the evaluation of renal lymphoma. Leuk Lymphoma 1994; 16:37-50. [PMID: 7696930 DOI: 10.3109/10428199409114138] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Renal lymphoma usually is a manifestation of disseminated disease and often is asymptomatic. Occasionally, the kidney(s) may be the major or only demonstrable site of disease, which may then present with a variety of urologic symptoms. The imaging studies should be tailored according to the presenting symptoms and prior history. Currently CT with intravenous contrast material enhancement is the study of choice for both the evaluation of renal involvement as well as staging of the disease. When necessary, CT or sonography may be used to guide percutaneous needle biopsy of suspicious masses. The role of the various imaging techniques, including MR and positron emission tomography, in the evaluation of renal lymphoma is discussed.
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Affiliation(s)
- P J Eisenberg
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
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Brouland JP, Meeus F, Rossert J, Hernigou A, Gentric D, Jacquot C, Diebold J, Nochy D. Primary bilateral B-cell renal lymphoma: a case report and review of the literature. Am J Kidney Dis 1994; 24:586-9. [PMID: 7942815 DOI: 10.1016/s0272-6386(12)80217-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Renal lymphoma is commonly secondary to lymphomatous infiltration of the kidneys in disseminated lymphoma and advanced stage IV disease. We describe a 57-year-old white woman presenting with an acute renal failure due to a bilateral "primary" B-cell lymphoma infiltration of the kidneys. The diagnosis of the lymphoma was made by renal biopsy. The striking feature observed was a destructive infiltration of the kidney by a malignant B-cell lymphoma that left the renal capsule intact, without any sign of secondary localization on the hilar regions. Physical examination did not reveal any peripheral lymphadenopathy or hepatosplenomegaly. A bilateral infiltration of both kidneys was the only feature shown by computed tomography and renal angiography. This case raises the question of the occurrence of a primary B-cell lymphoma in a nonlymphoid organ, which was diagnosed by renal biopsy at a time when the development was exclusively renal in origin.
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Affiliation(s)
- J P Brouland
- Unité INSERM U 28, Département de Néphrologie, Hôpital Broussais, Paris, France
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25
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Morel P, Dupriez B, Herbrecht R, Bastion Y, Tilly H, Delannoy A, Haioun C, Nouvel C, Bouabdallah K, Baumelou E. Aggressive lymphomas with renal involvement: a study of 48 patients treated with the LNH-84 and LNH-87 regimens. Groupe d'Etude des Lymphomes de l'Adulte. Br J Cancer 1994; 70:154-9. [PMID: 7517172 PMCID: PMC2033328 DOI: 10.1038/bjc.1994.267] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In order to describe renal involvement in aggressive non-Hodgkin's lymphomas (NHLs) and its prognostic significance, we reviewed the outcome of 48 patients with renal involvement treated with the LNH-84 or LNH-87 regimen. Histology was diffuse large cell in 29 (60%) patients; immunoblastic, diffuse mixed cell and lymphoblastic in four each; follicular large cell, diffuse small cleaved cell and diffuse small non-cleaved cell in one each; and unclassified in four. Ann Arbor stage was IV in 44 patients, and IE or IIE in four. Tumour mass > or = 10 cm, performance status (ECOG scale) > 2 and increased LDH level were present in 69%, 20% and 76% of patients respectively. Fifteen patients (31%) had multiple intraparenchymal nodules, 14 (29%) had direct spread into the kidney from a perirenal mass, ten (21%) had a single intraparenchymal nodule and nine (19%) had diffuse infiltration. Twenty-one patients (43%) presented with bilateral lesions. Three patients (6%) presented with acute renal failure. Ten other patients (21%) had serum creatinine > 120 mumol l-1. In 12 of these 13 patients renal function was restored with chemotherapy. Twenty-eight patients (57%) achieved complete remission. Estimated 4 year disease-free survival was 39%. Disease-free survival and actuarial survival at 4 years were estimated to be 58% respectively. Two renal parameters had adverse prognostic significance for survival: renal hilum involvement (P = 0.02) and diffuse renal infiltration (P = 0.01). A Cox model identified only two independent prognostic factors for survival, namely performance status > or = 2 and tumour size > or = 10 cm. We conclude that alteration in renal function occurs in 27% of patients with renal involvement. Systemic chemotherapy improves renal function rapidly. Long-term outcome is similar to that expected in NHL patients presenting with the same prognostic factors.
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Affiliation(s)
- P Morel
- Service des Maladies du Sang, CHRU Lille, France
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26
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Abstract
Lymphomatous involvement of the kidneys is a common manifestation of systemic non-Hodgkin's lymphoma but associated renal dysfunction is uncommon. In contrast, lymphoma originating within the kidneys is a rare event. We report a case of primary renal lymphoma presenting with renal insufficiency and hypertension in a 10-year-old boy.
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Affiliation(s)
- S F Dobkin
- Division of Pediatric Urology, Brown University Program in Medicine, Rhode Island Hospital, Providence
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27
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Sheil O, Redman CW, Pugh C. Renal failure in pregnancy due to primary renal lymphoma. Case report. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:216-7. [PMID: 2004059 DOI: 10.1111/j.1471-0528.1991.tb13372.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- O Sheil
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Headington
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28
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Katske F, Barbaric Z. A middle-aged man with dysuria and weight loss. Urology 1991; 37:126-8. [PMID: 1992580 DOI: 10.1016/0090-4295(91)80207-n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- F Katske
- Department of Surgery, University of California, Los Angeles Medical Center
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29
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 50-1990. A 65-year-old man with pharyngitis, upper-airway obstruction, and a rash. N Engl J Med 1990; 323:1689-97. [PMID: 2233966 DOI: 10.1056/nejm199012133232408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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Gianviti A, Boldrini R, Bosman C, Rizzoni G. Chronic renal failure due to kidney infiltration by Burkitt type lymphoma. Pediatr Nephrol 1989; 3:448-50. [PMID: 2642115 DOI: 10.1007/bf00850225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Chronic renal failure due to lymphomatous infiltration is rare. We report a case of end-stage renal failure due to bilateral massive lymphomatous infiltration confined to the kidneys and pancreas. Renal insufficiency was due to interstitial fibrosis and striking tubular atrophy.
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Affiliation(s)
- A Gianviti
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital, Rome, Italy
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