Acute kidney injury as first presentation of lymphoma: the role of renal biopsy

On, Wei; Udberg, Martin

doi:10.1136/bcr-2013-202196

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…There are some case reports, illustrating kidney pathology of AKI in lymphomas, and demonstrating LI in one case and light chain cast-nephropathy in another. 18,19 In the study from China kidney biopsy was performed in 18 out of 20 patients with NHL, only 5 of them presented with AKI, and in these patients pathology showed MPGN, intraglomerular lymphoma and intracapillary monoclonal IgM deposits. 20 Study of 49 patients with CLL and monoclonal B-cell lymphocytosis from Mayo clinic 16 reports renal failure (without distinguishing acute or chronic) in 34 (69%) cases.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in Hodgkin’s lymphoma, non-Hodgkin lymphoma/leukemia, and lymphoplasmacytic lymphoma: One center experience

Zakharova,

Makarova,

Leonova

et al. 2024

Journal of Onco-Nephrology

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Background: Acute kidney injury (AKI) is a common complication in patients with leukemia and lymphoma. In this single-center non-interventional retrospective study from 2010 to 2022, we aimed to evaluate causes, clinical features, and pathology finding in patients with Hodgkin lymphoma (HL), non-Hodgkin lymphoma/leukemia (NHL/CLL), or lymphoplasmacytic lymphoma (LPL) and AKI. Methods: We identified 101 patients with HL, NHL/CLL, and LPL. We analyzed AKI incidence and various clinical, laboratory, and pathology parameters and outcomes. Results: About 46.5% of patients with HL, NHL/CLL, and LPL presented with AKI. The incidence of AKI was the highest in the CLL setting (65.0%), it was lower and almost equal (48.0% and 47.0%) in NHL and HL, respectively, and the lowest (14.2%) in LPL. Study group comprised of 47 patients, M/F 31/16, median age was 64.0 [52.0; 71.0] years, and the patients with HL were significantly younger ( p = 0.022). The median disease duration prior to the AKI presentation was 14 [5; 44] months. Pre-renal AKI was diagnosed in 48.9% of cases: tumor lysis syndrome (TLS), specific lymphoid infiltration (LI), and post-renal AKI presented in 12.7% each. Kidney biopsy in 49% of patients revealed LI in 39.1% of cases. Focal segmental glomerulosclerosis presented in 21.7% of cases, proliferative glomerulonephritis with monoclonal immunoglobulin deposits in 13.0%, AA amyloidosis, IgA nephropathy, and AA amyloidosis in 8.6% each. AKI recovered in 63.8% of patients and 59.5% of patients were alive and dialysis-free at last evaluation: 100% with HL versus 58.3%, 46.1%, and 0% with NHL, LL, and LPL, respectively ( p = 0.025); and 8.5% remained alive on dialysis. About 25.5% of patients died after discontinuation or without need for dialysis; and 6.3% died on dialysis. Conclusion: AKI in patients with leukemia and lymphoma is heterogeneous and most commonly caused by volume depletion. AKI recovery, though not complete, occurred in 63.8% of cases with 68% survival.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury in Hodgkin’s lymphoma, non-Hodgkin lymphoma/leukemia, and lymphoplasmacytic lymphoma: One center experience

Zakharova,

Makarova,

Leonova

et al. 2024

Journal of Onco-Nephrology

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“…Several case series from autopsies performed in patients who had lymphoma show that the presence of malignant lymphocytes in the kidneys may occur more commonly than clinically suspected 6–10. One small case series demonstrated that while 14% of patients had been diagnosed with renal infiltration by their lymphoma, autopsies showed that there were actually 34% of patients with renal involvement 10.…”

Section: Discussionmentioning

confidence: 99%

“…This under diagnosis is likely due to most patients lacking clear clinical and/or radiological findings of renal lymphocytic invasion 8 9. However, clinically relevant renal involvement in low grade B-cell lymphoproliferative malignancies does remain rare 1–4 7 11–24…”

Section: Discussionmentioning

confidence: 99%

Marginal zone lymphoma causing accelerated progression of chronic kidney disease

et al. 2019

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A 75-year-old man with stage IV chronic kidney disease due to type 2 diabetes mellitus, presented with increasing proteinuria and rapidly declining renal function despite excellent glycaemic control. Investigations organised to assess his suitability for renal transplantation included an abdominal CT scan, which revealed extensive intra-abdominal lymphadenopathy. A 17fluorodeoxyglucose (FDG)-positron emission tomography scan to further characterise the lymphadenopathy demonstrated activity in the lymph nodes, as well as both kidneys. Following a lymph node biopsy and flow cytometry he was diagnosed with a marginal zone lymphoma. A subsequent kidney biopsy confirmed lymphomatous infiltration of the kidney. Marginal zone lymphoma is an uncommon type of non-Hodgkin's lymphoma, and renal involvement is rare. This case highlights the importance of considering alternative diagnoses when there is deviation from the expected clinical trajectory and the importance of liaising with colleagues in other disciplines to enable an accurate diagnosis to be made.

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Acute nephrotoxicity an unusual side effect or adverse toxicity of Captagon

Abu-Farsakh¹,

Farsak²,

Aljaras³

et al. 2018

ICPJL

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medical history and revealed no prior kidney diseases. On physical examination, his blood pressure was 162/93mmHg, heart rate was 96beats per minute, respiratory rate was 24. He had significant bilateral lower limbs edema. Abdominal examination showed tenderness over his costo vertebral angles bilaterally. Initial complete blood count (CBC) showed hemoglobin 11grams/ dL, total leukocyte count of 9×10 9 /L and platelet count of 460000/ µL. No schistocytes were found on peripheral blood smear. A blood chemistry panel showed urea nitrogen 27mg/dL (8-21mg/ dL), creatinine 1.1mg/dL (0.8-1.3mg/dL), sodium 136mmol/L (135-145mmol/L), potassium 4.2mmol/L (3.5-5mmol/L), calcium 8.1mg/dL (8.5-10.2mg/dL), glucose 93mg/ dL (65-110mg/dL), LDH 240 U/L (120-220U/L), albumin 3.0g/dL (3.5-5.0g/dL), and total protein 3.2g/dL (5.0-9.0g/dL), HCO 3 20mEq/L (22-29mEq/L). Liver function test was normal. Urinalysis revealed protein (+), with increased red blood cells, no eosinophiluria. Serologic test results for anti-nuclear antibody, anti-double-stranded DNA antibody, rheumatoid factor, cryoglobulinemia, hepatitis B and C, and ANCA were negative. Serum C3 and C4 levels were normal. Chest X-ray showed moderate amount of bilateral pleural effusion. Non-enhanced computed tomography (CT) scan for the abdomen was done to rule out nephrolithiasis as a cause of his presentation, the scan did not reveal any kidney stone or hydronephrosis. Kidney size was normal.

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Acute kidney injury as first presentation of lymphoma: the role of renal biopsy

Cited by 3 publications

References 11 publications

Acute kidney injury in Hodgkin’s lymphoma, non-Hodgkin lymphoma/leukemia, and lymphoplasmacytic lymphoma: One center experience

Acute kidney injury in Hodgkin’s lymphoma, non-Hodgkin lymphoma/leukemia, and lymphoplasmacytic lymphoma: One center experience

Marginal zone lymphoma causing accelerated progression of chronic kidney disease

Acute nephrotoxicity an unusual side effect or adverse toxicity of Captagon

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