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Lee SB, Yoon YM, Hong R. Primary renal lymphoma presenting as renal failure: A case report and review of literature from 1989. World J Clin Cases 2023; 11:7113-7126. [PMID: 37946781 PMCID: PMC10631424 DOI: 10.12998/wjcc.v11.i29.7113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/21/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Primary renal lymphoma (PRL) is extremely rare with an incidence of 0.7% among extranodal lymphomas. Occult renal lymphoma, which mimics medical renal disease and bilateral renal involvement, presents a diagnostic challenge to nephrologists and radiologists as the clinical and radiological findings are mostly non-specific or inconclusive. Acute kidney injury (AKI) is not an uncommon finding in renal infiltration due to malignant lymphoma. However, only 14% of cases are detected before death, and the low diagnostic rate may be due to the non-specific clinical manifestations of renal involvement, with only 0.5% of these cases presenting with AKI. Moreover, PRL is difficult to diagnose based on clinical, biochemical, and radiologic features, especially, in the case of bilateral diffuse involvement. CASE SUMMARY Herein, we report a 74-year-old woman with primary diffuse large B-cell lymphoma who presented with AKI diagnosed by ultrasound-guided needle biopsy. We also report the clinicopathologic findings of 121 PRL cases reported since 1989, by conducting a literature review of published cases. CONCLUSION A timely renal biopsy provides the most expedient means of establishing the diagnosis. Thus, early identification of the disease by the clinician facilitates early diagnosis toward effective treatment.
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Affiliation(s)
- Seul-Bi Lee
- Department of Hemato-Oncology, Medical School, Chosun University, Gwangju 61453, South Korea
| | - Young-Min Yoon
- Department of Nephrology, Medical School, Chosun University, Gwangju 61453, South Korea
| | - Ran Hong
- Department of Pathology, Medical School, Chosun University, Gwangju 61453, South Korea
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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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3
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Swain M, Nuguri S, De Padua M, Gowrishankar S. Renal lymphoma diagnosed on kidney biopsy presenting as acute kidney injury. Indian J Nephrol 2022; 32:342-347. [PMID: 35967526 PMCID: PMC9364996 DOI: 10.4103/ijn.ijn_345_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction: Renal manifestations associated with hematolymphoid malignancies are known. Primary or secondary involvement of the kidney by lymphomatous infiltration has various clinical presentations. Acute kidney injury is not an uncommon finding in relation to lymphomatous interstitial infiltration proven on kidney biopsy. However, diagnosing it solely on renal biopsy remains a challenge and needs expertise and aid of immunohistochemistry as the prognosis is dismal. Methods: This is a retrospective study of kidney biopsy-proven cases of renal lymphoma presenting with acute kidney injury. Results: The study included 12 patients with ages ranging from 4 to 50 years who presented with serum creatinine ranging 2.1–9.6 mg%. Renal biopsy findings showed interstitial lymphomatous infiltrate. Two cases were diagnosed as primary lymphoma and the other 10 as secondary lymphomas. Among the 12 cases, nine were B-cell non-Hodgkin lymphoma, of which diffuse large B-cell lymphoma was diagnosed in six (50%), low-grade B-cell type in two (16.6%), chronic lymphocytic leukemia in one (8.3%), and three were T-cell-type. Two were acute T-cell lymphoblastic lymphoma and one other was a high-grade T-cell lymphoma. Four patients succumbed. The other four patients are alive; one is on chemotherapy, while two of them are on hemodialysis. Conclusion: Acute kidney injury as a presenting feature with lymphomatous infiltration of renal parenchyma is not uncommon. The patchy involvement makes it challenging on kidney biopsy with definitive diagnosis being made with the help of immunohistochemistry. Appropriate multidisciplinary involvement improves patient outcome.
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Geramizadeh B, Shojazadeh A, Marzban M. Primary renal non-Hodgkin's lymphoma: A narrative review of literature. Urologia 2021; 89:185-194. [PMID: 33506743 DOI: 10.1177/0391560321990271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal involvement by Non-Hodgkin's lymphoma (NHL) is very rare, and involvement of the kidney as the primary site of NHL (PRNHL) is much more uncommon. Gold standard for the diagnosis of PRNHL is histology and imaging modalities although helpful are not specific. Nephrectomy has been mostly recommended for low grade lymphomas, and for high grade PRNHLs, chemotherapy without nephrectomy has been recommended as the treatment of choice. This tumor is aggressive with poor prognosis. This poor prognosis is partly because of delayed diagnosis and partly because of unnecessary surgeries, so it should be kept in mind, especially in bilateral renal tumors with unusual imaging characteristics, to take a tissue biopsy before nephrectomy. In this review, we will discuss all the detailed aspects of clinical, pathologic, and imaging characteristics of 83 cases of PRNHL reported in the last 20 years in the English literature so far. For this purpose, all the published cases of the primary non-Hodgkin's lymphoma of kidney were reviewed via a search in PubMed, Scopus, and Google Scholar, (1999-2019), using the keywords of "Primary renal lymphoma" and "Non-Hodgkin's lymphoma and kidney," "renal Non-Hodgkin's lymphoma," "renal lymphoma," and "lymphoma and kidney." There were 83 cases in the published English literature which were reviewed for this article. There was some missing information in some cases which has been recorded as "not reported."
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shojazadeh
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Marzban
- University of British Columbia, Vancouver, BC, Canada
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5
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Bokhari SRA, Inayat F, Bokhari MR, Mansoor A. Primary renal lymphoma: a comprehensive review of the pathophysiology, clinical presentation, imaging features, management and prognosis. BMJ Case Rep 2020; 13:13/6/e235076. [PMID: 32554453 DOI: 10.1136/bcr-2020-235076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary renal lymphoma (PRL) is defined as a non-Hodgkin's lymphoma restricted to kidneys with the absence of extensive nodal disease. It is an exceedingly rare clinicopathological entity, accounting for 0.7% of extranodal lymphomas. Published medical literature regarding the natural history and clinical outcomes of PRL remains limited. We describe a case of a young patient who presented with left shoulder pain, continuous fever, and unexplained weight loss as atypical initial manifestations of bilateral PRL, confirmed with the standard set of investigations. Furthermore, this article reviews the literature and discusses various aspects of PRL, including pathophysiology, presentation patterns, imaging and pathological characteristics, management, and prognosis. This paper serves to provide an update and aims to enhance the understanding of PRL. Timely diagnosis and treatment are imperative to achieve improved outcomes. Clinicians should maintain a high index of suspicion in order to prevent morbidity and mortality associated with this serious disease.
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6
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Chen J, Peng J, Zheng Y, Li S, Yang P, Wu X, Tian H, Liu H, Yang S, Wang W, Wu B. Primary renal lymphoma: a population-based study in the United States, 1980-2013. Sci Rep 2019; 9:15125. [PMID: 31641184 PMCID: PMC6805900 DOI: 10.1038/s41598-019-51635-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/03/2019] [Indexed: 01/15/2023] Open
Abstract
Primary renal lymphoma (PRL) is a rare lymphoid malignancy with only a few cases reported in the literature. We performed a population-based study of PRL to determine its incidence, clinical characteristics and factors associated with survival using the Surveillance, Epidemiology, and End Results (SEER) database. We identified 723 patients with PRL. The most common histological subtype of PRL was diffuse large B-cell lymphoma (56.3%). The incidence and mortality rate of PRL was 0.053/100,000 person-years and 0.036/100,000 person-years, respectively. The incidence rate of PRL was increasing significantly with an annual percentage change (APC) of 3.45% (p < 0.001). The 1-year and 5-year relative survival (RS) rates of patients with PRL were 78% and 64%. The RS of patients diagnosed between 2000 to 2013 was better than that of patients diagnosed between 1980–1999. A multivariate Cox hazards regression analysis revealed that older age, male gender, diagnosis before 2000, advanced stage, not receiving surgical treatment, and DLBCL or T/NK cell lymphoma type were independent predictors of unfavorable survival.
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Affiliation(s)
- Jiayuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiangtong Peng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yongqiang Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sen Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Pengcheng Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiangyi Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - He Tian
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hui Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shengli Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wenjing Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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7
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Primary Pleomorphic Mantle Cell Lymphoma of Kidney: A Case Report. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.10203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Shetty S, Singh AC, Babu V. Primary Renal Lymphoma - A Case Report and Review of Literature. J Clin Diagn Res 2016; 10:XD05-XD07. [PMID: 27790565 PMCID: PMC5072065 DOI: 10.7860/jcdr/2016/20901.8577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Abstract
Primary Renal Lymphoma (PRL) is rare and its existence has been called into question due to the absence of lymphatic tissue within renal parenchyma. Non-specific abdominal pain with mass in the lumbar region and otherwise unexplained renal failure is the most common presentation. Almost all patients eventually develop extrarenal lymphomatous disease and few patients survive beyond one year. Surgical treatment is rarely feasible as primary modality of treatment since the tumour often encases major vessels and surrounding organs necessitating major resection. Instead, an attempt can be made to downstage the tumour with chemotherapy before attempting surgery. Here we present a case of primary renal Non-Hodgkins Lymphoma (NHL) which was treated with chemotherapy but the patient succumbed to disease before the third cycle.
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Affiliation(s)
- Shraddha Shetty
- Resident, Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Avinash Chandra Singh
- Resident, Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Vinod Babu
- Resident, Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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9
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Vankalakunti M, Rohan A, Vishwanath S, Rampure S, Bonu R, Babu K, Ballal HS. Spectrum of renal involvement in hematolymphoid neoplasms: Renal biopsy findings of 12 cases. Indian J Nephrol 2015. [PMID: 26199470 PMCID: PMC4495473 DOI: 10.4103/0971-4065.139093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Spectrum of causes for renal dysfunction in patients with hematolymphoid malignancy (excluding plasma cell dyscrasia) is varied. A retrospective evaluation of “native” renal biopsies referred to our institute during the period from January 2010 to December 2013 revealed 12 cases. Age ranged between 7 and 69 (median 54.5) years. All patients were males. The neoplasms included non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute lymphoblastic leukemia, Burkitt's lymphoma, intravascular lymphoma, Hodgkin lymphoma and chronic myeloid leukemia. Proteinuria was noted in 66% of the patients (nephrotic range in 5, subnephrotic range in 3). Renal insufficiency was noted in 100% patients. Malignancy-related kidney injury was noted in 75% of the cases. Renal histology showed lymphomatous infiltration (8), membranoproliferative glomerulonephritis (MPGN) (3), intracapillary monoclonal deposit disease (1) and intravascular lymphoma (1). Distribution of lymphomatous infiltration was diffuse in 50% and focal in 50%. We observed that renal dysfunction was predominantly a direct effect, that is, lymphomatous invasion. Paraneoplastic glomerulopathic changes occur in the form of MPGN. Proteinuria of >2 g/day correlated with glomerular disease.
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Affiliation(s)
- M Vankalakunti
- Department of Pathology, Manipal Hospital, Bengaluru, Karnataka, India
| | - A Rohan
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - S Vishwanath
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - S Rampure
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - R Bonu
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
| | - K Babu
- Department of Pathology, Manipal Hospital, Bengaluru, Karnataka, India
| | - H S Ballal
- Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
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10
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Prabhakar D, Gupta KL, Gochhait D, Nada R, Varma SC, Kumar V, Rathi M, Kohli HS, Sakhuja V, Ramachandran R. Rapidly progressive renal failure in a patient with extranodal non-Hodgkin's lymphoma. Indian J Nephrol 2015; 25:43-5. [PMID: 25684871 PMCID: PMC4323911 DOI: 10.4103/0971-4065.140723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 60-year male was admitted with advanced renal failure and bilaterally enlarged kidneys. Kidney biopsy revealed diffuse interstitial infiltration by CD20 + lymphomatous cells suggestive of diffuse large B-cell, non-Hodgkin's lymphoma. Bone marrow examination was negative for malignant cells. Positron emission tomography-computed tomography showed uniformly diffuse and avid flurodeoxy glucose uptake in both kidneys, multiple hypodense areas of both lobes of liver, and axial and appendicular skeleton. Patient was treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine and prednisolone, became afebrile and serum creatinine normalized.
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Affiliation(s)
- D Prabhakar
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K L Gupta
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D Gochhait
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S C Varma
- Department of Clinical Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Kumar
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Rathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - H S Kohli
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Sakhuja
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Ramachandran
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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11
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Kwakernaak AJ, Hazenberg MD, Roelofs JJTH, van Noesel CJM, van Oers MHJ, van Tellingen A. Precursor T-lymphoblastic lymphoma presenting as primary renal lymphoma with acute renal failure. NDT Plus 2011; 4:289-91. [PMID: 25984171 PMCID: PMC4421737 DOI: 10.1093/ndtplus/sfr079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/01/2011] [Indexed: 02/06/2023] Open
Abstract
We report a case of acute renal failure (ARF) and bilateral nephromegaly in a patient with a history of Crohn’s disease and treatment with azathioprine. Kidney biopsy revealed diffuse renal infiltration by precursor T-cell lymphoblastic lymphoma (T-LBL). At the time of diagnosis, no extrarenal manifestations of the lymphoma were detectable and therefore the lymphoma was categorized as primary renal lymphoma (PRL). Thus far, precursor T-LBL presenting as PRL has not been described before. We emphasize that in patients with ARF and bilateral renal enlargement, renal lymphoma is an important differential diagnostic consideration.
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Affiliation(s)
- Arjan J Kwakernaak
- Department of Medicine, Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mette D Hazenberg
- Department of Medicine, Division of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carel J M van Noesel
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marinus H J van Oers
- Department of Medicine, Division of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne van Tellingen
- Department of Medicine, Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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12
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A 30-month-old Child With Acute Renal Failure Due to Primary Renal Cytotoxic T-cell Lymphoma. Am J Surg Pathol 2010; 34:1066-70. [DOI: 10.1097/pas.0b013e3181de693c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Sakhuja V, Agarwal R, Kalra N. A case of fever and unexplained acute renal failure. Indian J Nephrol 2010; 18:86-94. [PMID: 20142912 PMCID: PMC2813127 DOI: 10.4103/0971-4065.42353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Cupisti A, Riccioni R, Carulli G, Paoletti S, Tognetti A, Meola M, Francesca F, Barsotti G, Petrini M. Bilateral primary renal lymphoma treated by surgery and chemotherapy. Nephrol Dial Transplant 2004; 19:1629-33. [PMID: 15150359 DOI: 10.1093/ndt/gfh250] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Adamasco Cupisti
- Department of Internal Medicine, Nephrology Division, University of Pisa, Italy.
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15
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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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16
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Kemper MJ, Bergsträsser E, Pawlik H, Gaspert A, Neuhaus TJ. An 8-year old boy with recurrent macroscopic hematuria, weight loss, and kidney failure. J Pediatr 2003; 142:342-5. [PMID: 12640387 DOI: 10.1067/mpd.2003.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Markus J Kemper
- University Children's Hospital and Department of Pathology, University Hospital, Zürich, Switzerland.
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