Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits

Abstract

In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.

Renal lymphoma diagnosed on kidney biopsy presenting as acute kidney injury

“…In this study, of the 10 cases of secondary renal lymphomas, few had other associated clinical findings as described in Table 1 . All the cases presented with acute kidney injury with increased serum creatinine, similar to that of various articles published in the literature,[ 1 7 8 9 10 11 12 13 14 15 16 ] and were categorized into different variants of lymphomas [ Table 2 ].…”

“…Renal disease prevalence in patients with hematologic malignancies is variable, ranging from 7% to 34%. [ 1 ] Depending on the involvement pattern, the clinical manifestations vary from paraneoplastic glomerulopathies to interstitial lymphomatous infiltration where they present with acute renal dysfunction, which requires immediate diagnosis and treatment. [ 1 ] Acute kidney injury (AKI) due to lymphomatous infiltration of the kidney is seen in approximately 1%.…”

“…[ 1 ] Depending on the involvement pattern, the clinical manifestations vary from paraneoplastic glomerulopathies to interstitial lymphomatous infiltration where they present with acute renal dysfunction, which requires immediate diagnosis and treatment. [ 1 ] Acute kidney injury (AKI) due to lymphomatous infiltration of the kidney is seen in approximately 1%. [ 2 ] Renal involvement as a part of systemic lymphoma has been mentioned in the literature in one of the autopsy studies with a prevalence of up to 60%–90%.…”

“…[ 2 ] Renal involvement as a part of systemic lymphoma has been mentioned in the literature in one of the autopsy studies with a prevalence of up to 60%–90%. [ 1 2 3 ] Primary lymphomas of the kidney are rare, accounting for approximately 1%. [ 4 ] In the literature, many single case reports of renal lymphomas presenting with kidney injury are documented, whereas very few case series are available.…”

Malignancy diseases and kidneys: A nephrologist prospect and updated review

“…[ 33 ] Rarely, additional hematological malignancies such as Waldenstrom macroglobulinemia, chronic lymphocytic leukemia, or lymphoma may be linked to light chain cast nephropathy. [ 46 ]…”