Napoli Marcello, Montinaro A M, D'Ambrosio E, Di Renzo N, Ambrosino C, Lefons M, Pati C, Sozzo E
G Ital Nefrol. 2014 Jan-Feb;31(1).
The bilateral primary renal lymphoma (PRL) is a rare disease with a high mortality rate (75% within the first year). We report the case of a fifty-three years old women observed in January 2011 for renal colic. Ultrasonography showed hypoechoic lobular formations in the kidney. Blood tests showed: creatinine 1.8 mg/dl, urea 75 mg/dl , Creatinine Clerance 35 ml/m, hemoglobinemia 11 g/dl, with blood cells 8.500/mcL, Albumin 2.8 g/dl, Beta -2 micro - 27.3/mL. Proteinuria was 0.3 g/24 hours. The CT scan showed kidneys with larger dimensions and multiple hypodense areas infiltrating the renal parenchyma with contrast-enhanced low in which kidneys had lesions similar to "leopard skin". The CT scan showed no enlarged lymph nodes. Renal biopsy showed: renal parenchyma largely occupied by infiltration of lymphoid elements, small and medium-sized, densely packed with compression of the tubular structures . Immunofluorescence for immunoglobulin (Ig) G, IgA, IgM, C3, C4, C1q, fibrinogen, kappa and lambda were negative. The bone marrow biopsy excluded lymphomatous infiltration. The histological diagnosis was "non-Hodgkin's B-cell lymphoma"; the clinical diagnosis was LRBP. The patient was treated by 6 cycles of R-CHOP-21 protocol (rituximab - endoxan, adriblastina , vincristine, prendnisone), the latter of which practiced in August 2011. The pt is currently in follow-up hematology and nephrology . The first TAC control , in October 2011, showed a complete regression of the lesions infiltrating . This finding was confirmed by two other CT scan performed in February and October 2012. The last blood tests of February 2013 showed : creatinine 1.1 mg / dl , Urea 40 mg/dl, proteinuria absent. Currently, the pt is asymptomatic and is being treated by low dose of ACE inhibitor. The bilateral PRL is considered a severe disease with one-year mortality of 75% . The successful outcome of the case described can be attributed to haematological therapy and to the early diagnosis.
双侧原发性肾淋巴瘤（PRL）是一种罕见疾病，死亡率很高（第一年高达75%）。我们报告一例2011年1月因肾绞痛就诊的53岁女性病例。超声检查显示肾脏有低回声小叶状结构。血液检查结果如下：肌酐1.8mg/dl，尿素75mg/dl，肌酐清除率35ml/m，血红蛋白11g/dl，血细胞计数8500/mcL，白蛋白2.8g/dl，β2微球蛋白27.3/mL。24小时蛋白尿为0.3g。CT扫描显示双肾增大，多个低密度区浸润肾实质，增强扫描呈低密度，双肾病变类似“豹皮”样。CT扫描未显示淋巴结肿大。肾活检显示：肾实质大量被中小淋巴细胞浸润占据，肾小管结构受压。免疫球蛋白（Ig）G、IgA、IgM、C3、C4、C1q、纤维蛋白原、κ和λ免疫荧光检查均为阴性。骨髓活检排除淋巴瘤浸润。组织学诊断为“非霍奇金B细胞淋巴瘤”；临床诊断为LRBP。患者接受了6个周期的R-CHOP-21方案（利妥昔单抗 - 环磷酰胺、阿霉素、长春新碱、泼尼松）治疗，最后一次治疗于2011年8月进行。患者目前在血液科和肾内科随访。2011年10月的首次CT检查显示浸润性病变完全消退。2012年2月和10月进行的另外两次CT扫描证实了这一结果。2013年2月的最后一次血液检查显示：肌酐1.1mg/dl，尿素40mg/dl，无蛋白尿。目前患者无症状，正在接受小剂量ACE抑制剂治疗。双侧PRL被认为是一种严重疾病，一年死亡率为75%。所述病例的成功结果可归因于血液学治疗和早期诊断。
