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Saleh M, Salih N, Kakakhel M, Ullah I, Siraj H, Tariq MN, Ahmad K. A Rare Presentation of Acute Kidney Injury in Diffuse Large B-Cell Lymphoma: A Case Report. Cureus 2023; 15:e45642. [PMID: 37868496 PMCID: PMC10589075 DOI: 10.7759/cureus.45642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Acute kidney injury from bilateral renal infiltration is rare in diffuse large B-cell lymphoma (DLBCL). We present the case of a 45-year-old woman with a three-month history of night sweats, weight loss, fever, and fatigue. Clinical evaluation revealed anemia, edema, cervical lymphadenopathy, and elevated blood pressure. Initial lab results indicated severe kidney injury, initially suspected to be chronic kidney disease, later ruled out. Radiological assessments confirmed mediastinal lymphadenopathy. A cervical lymph node biopsy led to a diagnosis of DLBCL. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy improved renal function and hematological parameters. Subsequent staging CT confirmed lymphadenopathy. Close monitoring revealed a complete return to normal renal function after one month. Further follow-up was missed. This case emphasizes diagnostic complexities and the value of a multidisciplinary approach in managing complex clinical presentations.
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Affiliation(s)
- Mahnosh Saleh
- Internal Medicine, Ayub Teaching Hospital, Abbottabad, PAK
| | - Noman Salih
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Musa Kakakhel
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Izhar Ullah
- Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Hamza Siraj
- Internal Medicine, Khyber Teaching Hospital Peshawar, Peshawar, PAK
| | | | - Kamran Ahmad
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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2
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Renal involvement of lymphomas proven by kidney biopsy: report of 10 cases from a tertiary care center and comparison with the literature. Int J Hematol 2022; 116:678-695. [PMID: 35829895 DOI: 10.1007/s12185-022-03411-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
Lymphomas localized in the kidney are a rare entity that may be challenging to diagnose. We analyzed data from 10 patients with renal involvement of lymphoma diagnosed between 2009 and 2019 on fine needle biopsy from our tertiary center, and compared these with findings of 160 cases reported in the literature. Diffuse large B-cell lymphoma was the main histology subtype (40 and 38% in our sample and in the literature, respectively), followed by low-grade B-cell lymphomas, mostly from the marginal zone (MZ). Altogether, 106 patients had urological inaugural symptoms and 64 had general symptoms. Patients with urological presentation more often had renal masses than diffuse infiltration (p < 0.001), unilateral tumors (p = 0.0036) and low-grade B-cell lymphomas (17 vs 6%, p = 0.043). In both groups, nearly one-fourth of patients had diffuse (stage IV) lymphomas. Overall survival did not differ by the presence of urological/systemic symptoms, stage or aggressive lymphoma status. Notably, 3 of 10 patients from our series had MZ lymphomas associated with primary Sjögren syndrome revealed by acute kidney injury, including one where the autoimmune disease was detected. Lymphoproliferative disorders localized in the kidney are a challenging condition that can lead to detection of aggressive or diffuse lymphomas.
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Abramson M, Mehdi A. Hematological Malignancies and the Kidney. Adv Chronic Kidney Dis 2022; 29:127-140.e1. [PMID: 35817520 DOI: 10.1053/j.ackd.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
The incidence of hematologic malignancies is on the rise worldwide. Kidney disease is ubiquitous in patients with hematologic malignancies, encompassing a wide spectrum of disorders involving each kidney compartment, including the vasculature, tubules, interstitium, and glomerulus, and there is significant overlap of kidney involvement with each hematologic malignancy. Vascular disorders include both microvascular and macrovascular damage, via thrombotic microangiopathy, hyperleukocytosis, hyperviscosity, and cryoglobulinemia. The tubulointerstitial compartment may be affected by prerenal azotemia and acute tubular injury, but malignant infiltration, tumor lysis syndrome, extramedullary hematopoiesis, cast nephropathy, granulomatous interstitial nephritis, and lysozymuria should be considered in certain populations. Obstructive uropathy may occur due to nephrolithiasis or retroperitoneal fibrosis. Glomerular disorders, including membranoproliferative, membranous, minimal change, and focal segmental glomerulosclerosis, can rarely occur. By understanding how each compartment may be affected, care can best be optimized for these patients. In this review, we summarize the widely varied etiologies of kidney diseases stratified by kidney compartment and hematologic malignancy, focusing on demographics, pathology, pathophysiology, mechanism, and outcomes. We conclude with common electrolyte abnormalities associated with hematologic malignancies.
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4
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Abdominal pain in a 5-year-old girl with bilateral nephromegaly: Answers. Pediatr Nephrol 2018; 33:423-426. [PMID: 28555298 DOI: 10.1007/s00467-017-3696-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 04/22/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Renal involvement in non-Hodgkin lymphoma is a recognized development, but it mostly follows a diagnosis of lymphoma. We describe a rare case of a T-cell-type non-Hodgkin lymphoma that first presents as nephromegaly in a 5-year-old girl admitted to the emergency department with abdominal pain. Further investigation revealed bilateral nephromegaly, but the results of blood tests, imaging studies, and bone marrow aspiration were inconclusive. During the second week of hospitalization, significant physical examination revealed an enlarged lymph node in the anterior cervical chains, confirming a diagnosis of Non-Hodgkin's lymphoma. This case illustrates that it is important to have a high degree of suspicion in any patient presenting with unexplained enlarged kidneys without any identifiable cause because it could be the first presentation of a hematologic malignancy.
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Diffuse large B-cell lymphoma presenting as bilateral renal infiltration leading to acute kidney injury. CEN Case Rep 2017; 6:140-147. [PMID: 28593485 DOI: 10.1007/s13730-017-0261-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022] Open
Abstract
Acute kidney injury (AKI) because of bilateral renal infiltration is an uncommon presentation of diffuse large B-cell lymphoma (DLBCL). A 52-year-old man presented to our institution with AKI and complaints of fatigue. Ultrasonography revealed a large, 15 cm granulomatous mass arising from the bilateral kidneys. The mass was biopsied laparoscopically, and histopathological analysis revealed evidence of DLBCL. The patient subsequently underwent R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Chemotherapy resulted in a rapid decrease in mass size and improvement in kidney function. However, after five courses of R-CHOP, relapse was observed in the central nervous system, and the patient died 220 days after the initial onset of AKI. Post-mortem analysis of renal tissue confirmed the initial diagnosis of DLBCL-associated renal infiltration. To our knowledge, this is the first report of DLBCL presenting as bilateral renal infiltration and AKI.
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6
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On W, Udberg M. Acute kidney injury as first presentation of lymphoma: the role of renal biopsy. BMJ Case Rep 2013; 2013:bcr-2013-202196. [PMID: 24293542 DOI: 10.1136/bcr-2013-202196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 65-year-old man with an insidious history of being generally unwell with weight loss, a poor appetite and night sweats was transferred to a tertiary nephrology unit after being found to be in acute kidney injury (AKI). A renal biopsy was performed on the same day which revealed lymphomatous infiltration of the renal parenchyma. He required temporary haemodialysis as he was oliguric and was started on chemotherapy. His renal function improved to baseline 3 weeks after treatment. This case illustrates the uncommon presentation of direct lymphomatous infiltration as a cause of AKI and the integral role of renal biopsy in ascertaining the diagnosis.
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Affiliation(s)
- Wei On
- Department of Medicine, Countess of Chester NHS Foundation Trust, Chester, UK
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Baran A, Küpeli S, Doğru O. A pediatric renal lymphoma case presenting with central nervous system findings. Turk J Haematol 2013; 30:191-3. [PMID: 24385785 PMCID: PMC3878465 DOI: 10.4274/tjh.03164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 02/13/2012] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED In pediatric patients renal lymphoma frequently presents in the form of multiple, bilateral mass lesions, infrequently as a single or retroperitoneal mass, and rarely as diffuse infiltrative lesions. In patients with apparent central nervous system involvement close attention to other physical and laboratory findings are essential for preventing a delay in the final diagnosis. Herein we present a pediatric patient with renal lymphoma that presented with central nervous system findings that caused a delay in diagnosis. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Ahmet Baran
- Diyarbakır Children's Diseases Hospital, Department of Radiology, Diyarbakır, Turkey
| | - Serhan Küpeli
- Diyarbakır Children's Diseases Hospital, Department of Pediatric Oncology, Diyarbakır, Turkey
| | - Omer Doğru
- Diyarbakır Children's Diseases Hospital, Department of Pediatric Hematology, Diyarbakır, Turkey
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Abdul-Rahman IS. Renal Disease in Hematological Malignancies. Int J Organ Transplant Med 2011. [DOI: 10.1016/s1561-5413(11)60002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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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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10
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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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Bakrac M, Bonaci B, Krstic M, Simic S, Colovic M. A rare case of enteropathy-associated T-cell lymphoma presenting as acute renal failure. World J Gastroenterol 2006; 12:2301-4. [PMID: 16610043 PMCID: PMC4087668 DOI: 10.3748/wjg.v12.i14.2301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Enteropathy-associated T-cell lymphoma (EATCL) is a high grade, pleomorphic peripheral T-cell lymphoma usually with cytotoxic phenotypes. We describe a first case of patient with EATCL that is remarkable for its fulminant course and invasion of both kidneys manifested as acute renal failure. The patient was a 23 year old woman with a long history of celiac disease. She was presented with acute renal failure and enlarged mononuclear infiltrated kidneys. Diagnosis of tubuloi-nterstitial nephritis and polyserositis was confirmed with consecutive pulse doses of steroid therapy. After reco-very, she had disseminated disease two months later. Magnetic resonance imaging showed thickened intestine wall, extremely augmented kidneys, enlarged intra-abdominal lymph nodes with extra-luminal compression of common bile duct. Laparotomy with mesenterial adipous tissue and lymph glands biopsy was done. Consecutive pathophysiological and immunohistochemical analyses confirmed the diagnosis of EATCL: CD45RO+, CD43+, CD3+. The revision of renal pathophysiology sub-stantiated the diagnosis. The patient received chemotherapy, but unfortunately she died manifesting signs of pulmonary embolism caused by tumor cells.
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Affiliation(s)
- Milena Bakrac
- Institute of Hematology, Clinical Center of Serbia, Koste Todorovica 2, 11000 Belgrade, Serbia.
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12
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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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13
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Törnroth T, Heiro M, Marcussen N, Franssila K. Lymphomas diagnosed by percutaneous kidney biopsy. Am J Kidney Dis 2004; 42:960-71. [PMID: 14582040 DOI: 10.1016/j.ajkd.2003.08.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Occult renal lymphoma clinically mimicking renal medical disease constitutes a diagnostic challenge to nephrologists, radiologists, and renal pathologists. The clinical and radiological findings, mostly nonspecific or inconclusive, seldom obviate the need for a kidney biopsy. METHODS AND RESULTS We report 5 new cases of diffuse bilateral renal lymphoma diagnosed by percutaneous kidney biopsy, all presenting with acute renal failure (ARF) of unknown cause. Three cases showed an interstitial and 2 an intraglomerular/intravascular type of lymphomatous infiltration. All tumors were of B-cell lineage. Our cases add to 50 similar cases reported since 1980. Considering all 55 cases together, 39 (87%) of the 44 cases with interstitial and 5 of 11 (45%) of those with intraglomerular lymphoma presented with ARF. In contrast, 5 of 10 cases with intraglomerular but none with interstitial infiltration presented with nephrotic range proteinuria. All but 2 cases (95%) with ARF and interstitial lymphoma but none with ARF and intraglomerular lymphoma showed bilaterally enlarged kidneys. Signs of extrarenal lymphomatous involvement were detected in 24 cases (44%) at the time of kidney biopsy or shortly thereafter. However, in only 10 cases (18%), all with interstitial lymphoma, was a tumor suspected prior to biopsy, mainly based on radiographical evidence of enlarged kidneys. CONCLUSION Both types of diffuse bilateral renal lymphoma may clinically mimic renal medical disease. ARF in interstitial and in intraglomerular lymphoma may be due to increased intrarenal pressure and intraglomerular obstruction, respectively. Percutaneous kidney biopsy provides the most expedient means of establishing the diagnosis. Differential diagnosis includes interstitial nephritis and proliferative glomerulonephritis.
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Affiliation(s)
- Tom Törnroth
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
OBJECTIVE The purpose of this study was to determine the incidence and to describe the CT findings of renal lymphoma in children. CONCLUSION Renal lymphoma was seen in 11 children, most commonly due to non-Hodgkin's lymphoma (n = 10, 91%) and Burkitt's subtype (n = 5, 45%). Multiple bilateral masses were the most common CT appearance. Less common presentations included focal solitary masses or an engulfing mass. Retroperitoneal lymph node enlargement and other organ involvements were common associated findings. Five of six patients with renal involvement at initial diagnosis have had cures or remissions. Therefore, renal involvement at the time of initial diagnosis with lymphoma does not portend a poor prognosis.
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Affiliation(s)
- Neeraj B Chepuri
- Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0252, USA
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15
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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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O'Riordan E, Reeve R, Houghton JB, O'Donoghue DJ, Waldek S. Primary bilateral T-cell renal lymphoma presenting with sudden loss of renal function. Nephrol Dial Transplant 2001; 16:1487-9. [PMID: 11427647 DOI: 10.1093/ndt/16.7.1487] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E O'Riordan
- Department of Renal Medicine, Hope Hospital, Salford, UK
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17
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Castellano I, Hernández MT, Gómez-Martino JR, Covarsí A, Bergua J, González MA. Acute renal failure as presentation of a Burkitt's lymphoma. Am J Kidney Dis 2000; 36:E32. [PMID: 11096060 DOI: 10.1053/ajkd.2000.20960] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute renal failure due to diffuse renal infiltration is rarely the presenting manifestation of non-Hodgkin's lymphoma. We report a patient with acute renal failure secondary to diffuse bilateral renal infiltration by a Burkitt's lymphoma. The presence of bilateral renal enlargement, an elevated serum lactate dehydrogenase (LDH), and lymphopenia should suggest the diagnosis, which can be confirmed by renal biopsy.
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Affiliation(s)
- I Castellano
- Division of Nephrology, the Department of Internal Medicine, the Hospital San Pedro de Alcántara, Cáceres, Spain.
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18
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Chin KC, Perry GJ, Dowling JP, Thomson NM. Primary T-cell-rich B-cell lymphoma in the kidney presenting with acute renal failure and a second malignancy. Pathology 1999; 31:325-7. [PMID: 10643001 DOI: 10.1080/003130299104675] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Infiltration of the kidney is commonly found in lymphoma, but acute renal failure arising from bilateral renal infiltration is uncommon. Primary renal lymphoma may occur and is usually of B-cell lineage. It is rare for patients with lymphoma to develop acute renal failure as their initial clinical presentation. Recently, an association between primary renal lymphoma and a second primary malignancy has been reported. We describe the first case of a renal T-cell-rich B-cell lymphoma presenting as acute renal failure, which was associated with a second primary pulmonary malignancy.
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Affiliation(s)
- K C Chin
- Department of Renal Medicine, Alfred Hospital, Melbourne, Australia
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Randhawa P, Demetris AJ, Pietrzak B, Nalesnik M. Histopathology of renal posttransplant lymphoproliferation: comparison with rejection using the Banff schema. Am J Kidney Dis 1996; 28:578-84. [PMID: 8840949 DOI: 10.1016/s0272-6386(96)90470-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The Banff schema for renal transplant pathology was applied to (1) nine specimens with renal posttransplant lymphoproliferative disease (PTLD) documented by Epstein-Barr virus in situ hybridization and analysis for B-cell lineage and (2) nine allograft nephrectomies classified as severe acute rejection (SAR) based on severe tubulitis, T-cell interstitial infiltration, and absence of Epstein-Barr virus. Tubulitis, venulitis, and infiltration of hilar soft tissues was demonstrable in all specimens. Hemorrhagic infarct-type necrosis was universal in SAR, but occurred in only three of the nine PTLD lesions (P < 0.05, Fisher's exact test). Arteritis in extrarenal vessels was more frequent (nine of nine SAR v four of nine PTLD) and severe (eight of nine Banff grade v3 SAR v four of nine Banff grade v1 PTLD) in SAR. Intrarenal arteries entrapped within PTLD showed grade v3 vasculitis in two cases. Expansile interstitial mononuclear infiltrates, nuclear atypia, and serpiginous necrosis were seen only in PTLD (nine of nine cases). It is concluded that the quality of the cellular infiltrate, its expansile nature, and the presence of serpiginous necrosis help distinguish between severe SAR and PTLD. Tubulitis and intimal arteritis, lesions regarded as specific for rejection in the Banff schema, do not have absolute discriminatory value in this clinical setting.
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Affiliation(s)
- P Randhawa
- Department of Pathology, University of Pittsburgh School of Medicine, PA, USA
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22
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Affiliation(s)
- R B Colvin
- Massachusetts General Hospital, Boston, USA
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23
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Prunart Renal Lymphoma. J Urol 1996. [DOI: 10.1097/00005392-199606000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dimopoulos MA, Moulopoulos LA, Costantinides C, Deliveliotis C, Pantazopoulos D, Dimopoulos C. Primary renal lymphoma: a clinical and radiological study. J Urol 1996; 155:1865-7. [PMID: 8618275 DOI: 10.1016/s0022-5347(01)66031-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE We assessed the incidence, clinical and radiological features, and prognosis of patients with renal lymphoma. MATERIALS AND METHODS We studied 210 patients with symptoms, signs and and radiological findings suggestive of renal cell carcinoma. RESULTS Final diagnosis in 6 of 210 patients (3%) was primary renal lymphoma. Radiological features were similar to those of renal cell carcinoma. Five of the 6 patients had an International Prognostic Index score of greater than 1. Despite appropriate chemotherapy, only 2 patients remain with complete remission. CONCLUSIONS Primary renal lymphoma is unusual but not rare. The relatively poor prognosis in our patients could be attributed to the adverse prognostic factors associated with aggressive nodal lymphomas.
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Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, University of Athens, Medical School, Greece
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25
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Manning EC, Belenko MI, Frauenhoffer EE, Ahsan N. Acute renal failure secondary to solid tumor renal metastases: case report and review of the literature. Am J Kidney Dis 1996; 27:284-91. [PMID: 8659508 DOI: 10.1016/s0272-6386(96)90555-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Renal metastases from solid tumors to both kidneys rarely result in acute renal failure (ARF). We present a case of squamous cell pulmonary carcinoma responsible for ARF due to (1) extensive (50% to 75%) bilateral parenchymal infiltration and replacement accompanied by tissue destruction, (2) widespread vascular invasion and thrombosis resulting in ischemia, and (3) histological evidence for foci of distal intratubular obstruction and pyelonephritis. Five additional cases, including one pulmonary cancer, causing ARF from extensive tissue replacement and destruction are reviewed. In a separate case, ARF resulted from lymphatic metastases rather than from parenchymal destruction or obstruction. Common findings in all six reported cases include bilaterally enlarged kidneys and progressive oligoanuria despite correction of prerenal or postrenal conditions. In our patient and in one other prior reported case, extrarenal obstruction was not considered important because invasive therapeutic procedures were unsuccessful in reversing ARF. In one case, irradiation of kidney tumor resulted in reversal of ARF. These cases emphasize the rare potential for solid tumors to metastasize to both kidneys and result in irreversible oligoanuric ARF. A high level of suspicion is required, and an early diagnosis may result in reversible ARF if the tumor is amenable to chemotherapy or irradiation.
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Affiliation(s)
- E C Manning
- Department of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA
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Abstract
BACKGROUND Primary renal non-Hodgkin's lymphoma (NHL) is rare. Because the renal parenchyma does not have lymphatics, the existence of this entity has been questioned. The goal of this study was to determine the clinical presentation, pathologic features, and disease course of patients with primary renal NHL and review the pertinent literature on this unusual extranodal NHL. METHODS All medical records from the Mayo Clinic from 1976 to 1992 with the diagnosis of renal NHL were retrospectively reviewed. One-hundred seventy-six cases were identified, five of which met the criteria for primary renal NHL. The clinical, pathologic, and radiographic features were reviewed in detail and are the basis of this report. RESULTS The median age at diagnosis of the five patients with primary renal NHL was 60 years (range, 52-63 years) with a male-to-female ratio of 2:3. All patients had flank pain as their initial presentation. Urinalysis was abnormal in only one patient. In three patients, the serum creatinine was elevated. Tumor histology was diffuse large cell in four cases; and small noncleaved non-Burkitt's in one. All five were B-cell immunophenotype. All patients received combination chemotherapy. Although the median survival for the group was only eight months, two remain in complete remission longer than 80 months from therapy. These two had total removal of macroscopic lymphoma and received combination chemotherapy and consolidation radiotherapy. CONCLUSIONS Primary renal non-Hodgkin's lymphoma does exist. Patients whose lymphomas were completely resected macroscopically and who received combination chemotherapy with consolidation radiation therapy had long disease free survival. Patients with bilateral renal involvement or no debulking of the renal lymphoma tended to have poorer survival.
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Affiliation(s)
- S H Okuno
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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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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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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Sumboonnanonda A, Veerakul G, Sukpanichnant S, Parichatikanond P. Clinical quiz. Tumor lysis syndrome. Pediatr Nephrol 1994; 8:641-3. [PMID: 7819018 DOI: 10.1007/bf00858152] [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: 01/27/2023]
Affiliation(s)
- A Sumboonnanonda
- Department of Paediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Mills NE, Goldenberg AS, Liu D, Feiner HD, Gallo G, Gray C, Lustbader I. B-cell lymphoma presenting as infiltrative renal disease. Am J Kidney Dis 1992; 19:181-4. [PMID: 1739103 DOI: 10.1016/s0272-6386(12)70131-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute renal failure is rarely the presenting manifestation of non-Hodgkin's lymphoma. Of the reported cases of renal insufficiency secondary to diffuse renal infiltration with lymphoma, few have presented with acute renal failure. We present a patient with acute renal failure secondary to diffuse bilateral renal infiltration by a B-cell non-Hodgkin's lymphoma. The findings of an elevated serum lactate dehydrogenase (LDH), lymphopenia, and homogenous bilateral renal enlargement on computed tomographic (CT) imaging were important in suggesting the diagnosis of primary renal lymphoma. Renal biopsy with immunohistochemical and ultrastructural analysis was instrumental in confirming this diagnosis.
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Affiliation(s)
- N E Mills
- Department of Medicine, New York University Medical Center, NY 10016
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Abstract
Lymphoma arising in the kidney is rare. Although 31 cases have been reported in the literature, it is likely that most of these neoplasms do not arise in the kidney. This report describes two cases of primary renal lymphoma and compares their clinical presentation, diagnostic modalities, treatment, and survival with the previously reported patients who satisfied our criteria for the diagnosis of primary renal lymphoma.
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Affiliation(s)
- G J Harris
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242
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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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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 41-1990. A 66-year-old woman with rapidly deteriorating renal function. N Engl J Med 1990; 323:1050-61. [PMID: 2215564 DOI: 10.1056/nejm199010113231508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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