Lymphoma and the Kidney: A Kidney Biopsy Teaching Case

Abstract

Lymphomatous infiltration of kidney parenchyma is a frequent complication of systemic hematologic malignancies and often shows subtle clinical presentation. Diffuse large B-cell lymphoma represents the most frequent form involving the kidney, with advanced stage at diagnosis, poor outcome, and risk for central nervous system relapse if not adequately treated. Kidney biopsy can provide specific and early detection of these cases, helping in the differential diagnosis with more frequent entities. Finally, further hematologic workup (bone marrow biopsy, complete blood cell count, and positron emission tomography) can distinguish secondary involvement of the kidney from the rarer kidney-limited forms, especially in patients without a previous diagnosis of lymphoma. Making a prompt and correct diagnosis directs the management of these cases and may improve the outcome, as described in the present report.

Primary diffuse large B-cell lymphoma of the kidney: A rare case report and review of literature

“…Kidney lymphoma usually develops secondarily in the setting of extensive lymph node disease/advanced stage lymphoma [ 1 , 2 , 5 ]. Primary kidney Lymphoma is defined as lymphoma arising from the kidney in the absence of adjacent primary tumor/extra renal localization [ 2 , 5 , 6 ]. Primary kidney lymphoma is rare, accounting for <1 % of all renal masses and < 0.7 % of extra nodal disease [ 1 , 2 , 5 , 7 ].…”

“…Primary kidney Lymphoma is defined as lymphoma arising from the kidney in the absence of adjacent primary tumor/extra renal localization [ 2 , 5 , 6 ]. Primary kidney lymphoma is rare, accounting for <1 % of all renal masses and < 0.7 % of extra nodal disease [ 1 , 2 , 5 , 7 ]. Similar to our patient, in most cases there is associated retroperitoneal lymph node enlargement [ 1 ].…”

“…Similar to our patient, in most cases there is associated retroperitoneal lymph node enlargement [ 1 ]. Among the NHL with kidney involvement, DLBL is the most common subtype [ [4] , [5] , [6] , [7] , [8] ]. Apart from lymphomas, there are a number of inflammatory conditions that can cause infiltrates of kidney lymphoid cells which includes interstitial nephritis, acute pyelonephritis, malakoplakia, and xanthogranulomatous pyelonephritis [ 2 , 5 ].…”

“…Other symptoms of lymphoma include weight loss, night sweats and fever collectively termed B symptoms [ 2 , 8 ]. Due to the non-specific symptoms, primary kidney lymphoma is confused with RCC as in the index case [ 1 , 5 , 7 ]. This can lead into delay in diagnosis, treatment and hence poor outcome [ 5 ].…”

Tumor lysis syndrome, acute kidney injury and disease-free survival in critically ill patients requiring urgent chemotherapy

“…The primary reported mechanisms of TLS-induced AKI are crystal nephropathies due to the precipitation of uric acid, xanthine and/or calcium phosphate crystals in renal tubules [ 2 ]. Nevertheless, in this context, other mechanisms can lead to acute tubular necrosis such as the release of pro-inflammatory cytokines impacting renal microcirculation but also tubulointerstitial lesions via tumor infiltration of the renal parenchyma or ureteral compression by tumor mass [ 8 , 9 ]. As defined by consensus definition, other clinical TLS manifestations are cardiac arrhythmia and seizures [ 3 ].…”