Renal failure incident to reticulum cell sarcoma of the kidneys. Response to radiotherapy

Chronic renal failure due to kidney infiltration by Burkitt type lymphoma

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.

Primary renal lymphoma presenting as acute renal failure

Diffuse bilateral infiltration of the kidneys by lymphoma cells is a rare but well-documented cause of acute renal failure (ARF). Only 51 such cases have been reported, 15 of which had ARF as the initial presentation of lymphoma. The clinical and pathologic features of these 15 cases and of two additional cases reported herein are reviewed. The diagnosis should be suspected in a patient with ARF, bilateral enlargement of the kidneys, minimal proteinuria, nonspecific findings on urinalysis, and absence of features of allergic tubulointerstitial nephritis. Renal imaging techniques may suggest the possibility of lymphomatous infiltration, but only renal biopsy or autopsy can provide a definitive diagnosis. Although modern chemotherapy and/or radiation therapy usually leads to a dramatic normalization of renal function, almost all patients eventually die of widespread recurrent lymphoma, despite the absence of clinical or pathologic involvement of the kidneys at the time of death.

Renal failure due to lymphomatous infiltration of the kidneys. Report of three new cases and review of the literature

Three new cases of renal failure due to lymphomatous infiltration of the kidneys are described and the clinical features of 14 similar patients in the literature are reviewed. The diagnosis of renal failure secondary to lymphomatous infiltration was made by ruling out other causes of renal failure and demonstrating prompt improvement in renal function after systemic chemotherapy or local irradiation of one or both kidneys. Histiocytic lymphoma was the most common underlying disease. In the setting of diffuse lymphoma with other causes of renal failure reasonably excluded, radiographic demonstration of enlarged kidneys without obstruction suggests the need for intensive combination chemotherapy in most cases.

Urinary cytodiagnostic abnormalities in 50 patients with non-Hodgkin's lymphomas

Urinary cytodiagnostic evaluation was performed on 50 consecutive patients with non-Hodgkin's lymphomas. In 14 patients (28%) the urine sediment contained characteristic lymphoma cells. The groups with or without a positive urine cytology were comparable with respect to type of lymphoma, stage and course of disease, and recent treatment with chemotherapy. However, those with a positive urine cytology were more likely to have clinical evidence of kidney disease (43% vs 8%), although this was rarely attributed to disseminated lymphoma. In fact, in three patients, a positive urine cytology was the sole or presenting evidence for disseminated lymphoma. Although the groups with or without a positive cytology were similar with regard to physicochemical urinary findings, there were marked differences in the frequency of microscopic abnormalities. All patients with a positive cytology had evidence of renal parenchymal necrosis, renal tubular injury, or pathologic cast formation as compared with only 56% of those with a negative cytology. Thus, urinary cytodiagnostic evaluation may provide an important adjunct in the staging and evaluation of patients with malignant lymphomas.

The abscopal effect: demonstration in lymphomatous involvement of kidneys

A patient with bilateral involvement of the kidneys with diffuse histiocytic lymphoma associated with renal failure is presented. This case report provides an example of the abscopal effect. Although only one kidney received radiation therapy, both kidneys were shown to respond to this treatment.

Acute renal insufficiency due to lymphomatous infiltration of the kidneys: report of six cases

Described are six patients with acute renal insufficiency due to histologically proven massive lymphomatous infiltration of the kidneys. All patients were admitted to a renal intensive care unit over a period of six years. Oliguria was the presenting symptom in two of the patients. This complication of lymphoma is suggested by enlargement of the kidneys and mild proteinuria in the absence of other causes of uremia and can be demonstrated by renal biopsy. Local radiation therapy performed in two patients produced improvement of renal function.